Job Description

Clinical Documentation Integrity Specialist Medicare Risk Adjustment at One Medical The Medicare Risk Operations team at One Medical promotes and supports our relentless commitment to deliver the highest quality care to our patients. We support our care team members by providing detailed clinical documentation practices, surfacing diagnoses for provider evaluation, and helping drive clinical decision making. Our mission on the Medicare Risk Operations team is to help our providers document the most accurate and comprehensive medical records possible to deliver high-quality, efficient, evidence-based care to our complex patients. The Opportunity: As a member of the Medicare Risk Operations (MRO) team and reporting to the Manager of CDI, the CDI specialist will be responsible for supporting One Medical Senior Health’s Medicare Risk Operations and other Medicare Population Health Programs in reviewing concurrent and retrospective medical records to evaluate the completeness of outpatient provider documentation in addition to auditing and educating providers across the Senior Health line of business. This role may be a good fit for you if you have strong attention to detail, excellent communication skills, knowledge of medical terminology and coding as well as an analytical & problem solving mindset. If you are passionate about healthcare improvement and want to be a part of a growing organization, we would love to hear from you! This is a full-time remote position based anywhere in the United States. What you'll likely work on: Reviews office notes of patients to identify the diagnoses in the HCC model and to assign a working HCC. Performs initial reviews, concurrent reviews and retrospective reviews to ensure there is adequate supporting documentation for HCC diagnoses in the note. Educates internal staff on clinical documentation and coding guidelines. Develops and conducts ongoing CDI education for new staff including coders, physicians, nurses, and behavioral health specialists. Develops and supports strong professional relationships with medical providers across the system. Does review sessions with clinicians in local markets via video or face to face when possible. Utilizes a compliant query process per guidelines and policy when conducting all queries. Follows each query through to closure including complete documentation of ongoing follow up activities and communication. Prospectively generates suspect conditions based on findings from chart review and assists in the creation of decision support logic. Assists in other monitoring activities, special department projects or other needs as determined by the department manager. Provide ongoing CDI team learning opportunities through sharing of professional knowledge. Maintains integrity and compliance in all chart reviews and CDI documentation and queries at all times. Review medical records to identify documentation that supports closure of HEDIS and other quality gaps and with other cross functional teams to submit to health plans via attestation or electronic filings as appropriate. Works closely with Operations Manager to implement MRO initiatives. What you’ll need: Minimum 3 years working as Clinical Documentation Specialist (CDS) Nurse or Clinical Documentation Integrity (CDI) Nurse Must be a Registered Nurse (RN) Minimum of 3 years inpatient or internal nursing experience required Must have CCS, CCDS or CDIP Knowledge of age-specific needs and the elements of disease processes and related procedures. Working Knowledge of the Medicare Advantage reimbursement system and HCC Coding required. Working knowledge of HEDIS quality specification Excellent written and verbal communication skills. Excellent critical thinking skills. Ability to work independently in a time-oriented environment. Tech savviness. Strong proficiency in Microsoft Windows, Word, Excel, PowerPoint and the Google suite of products, including Gmail and Calendar. One Medical is committed to fair and equitable compensation practices. The base salary range for this role is $90,000 to $110,000. However, actual compensation packages are based on several factors that are unique to each candidate. These factors include, but are not limited to, job related knowledge and skill set, depth of experience, certifications and/or degrees, and specific work location. The total compensation package for certain roles may also include additional components such as a sign-on bonus, annual performance bonus, equity grants in the form of RSUs, medical and other benefits and/or other applicable incentive compensation plans. For more information, please visit . #J-18808-Ljbffr One Medical

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