Job description
InnovaCare Partners, LLC
Skills and Specifications
Language Skills
Reasoning Ability
Physical and Mental Demand
The Clinical Documentation Improvement (CDI) Specialist is an expert in diagnostic coding, clinical indicators and documentation requirements. His or her performance ensures diagnostic coding accuracy and compliance for each patient. The CDI Specialist possesses an excellent ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding. Assists with various associated operational matters including appropriate scheduling, assignments and coverage of reviews. Works collaboratively with the CDI team to facilitate documentation within the medical record that supports MRA policies and procedures.
Responsibilities:
Support the VP of Medical Management in analyzing clinical and related reports.
Analyze data base on diagnosis, medical services, codes, and other indicators from reports and other tools.
Review medical documents such as surgical reports, medical visits, and diagnostic reports in order to create educational strategies to ensure correct diagnosis code assignment by the provider.
Review clinical documentation and assign accurate diagnosis codes according to guidelines and project
Be able to identify opportunities in diagnosis coding, clinical documentation and billing within the provider’s day-to-day operations.
Performs on-going educational interventions to providers to close gaps or related data
Maintains a log of reviewed cases and education performed of diagnosis/HCC gaps.
Prepares and submits to the supervisor a monthly report of activities performed.
Participates in training to maintain updated with CMS regulations
Performs other duties relevant to the position.
Skills and Specifications
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Must have ability to work as a team player with excellent communication skills.
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Must solve resource issue in a creative, positive manner.
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Must possess the ability to make independent decisions when circumstances warrant such action.
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Stay updated on CMS rules and guidelines.
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Must be able to use a laptop, Word, Excel and Outlook programs.
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Requires sitting and standing associated with a normal office environment; mobility to do audits at providers’ sites.
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Perform tasks requiring independent knowledge and judgment in addition to instructions and procedures provided.
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Must be able to function with frequent interruptions, accept change and able to prioritize activities when faced with competing demands.
General Skills
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Knowledge and interpretation of the systems of standard classification (CPT, ICD-10-CM and HCPCS)
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Knowledge and interpretation of the Risk Adjustment Factor and Stars Program payment methodologies of Medicare Advantage
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Knowledge of correct coding according to defined by CMS.
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Computer systems knowledge (Internet, Microsoft Office)
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Skill in enabling personnel
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Capacity of concentration and analysis
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Ability to work under pressure
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Organization/structure
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Responsibility
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Decision making capability in its area of expertise
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Didactic capacity
Language Skills
Bilingual (Spanish and English). Ability to read, analyze, and interpret general business periodicals, operating and maintenance instructions, procedure manuals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Mathematical Skills
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Reasoning Ability
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Physical and Mental Demand
Requires sitting and standing associated with normal office environment. Regularly talks and hears. This position requires that weight be lifted, or force be exerted up to 25 pounds.
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