Clinical Documentation Specialist, Risk Adjustment

The Clinical Documentation Specialist works independently and is responsible for performing clinical chart
reviews and pre-charting on risk adjustable patient populations. The Clinical Documentation Specialist
exercises critical thinking by applying clinical knowledge to correlate relevant diagnoses for the primary
care physician (PCP) to consider at the time of the face to face visit. The Clinical Documentation Specialist
will also be responsible for tracking and verifying all their findings.

Leads or provides education/training to clinical care and administrative support team members regarding
the clinical documentation requirements essential for risk adjustable diagnoses and their impact on
reimbursement and regulatory requirements set forth by CMS and other regulatory entities. Assists in
developing educational materials as needed.

•  Reviews and assesses medical charts clinically by suggesting risk adjustable diagnoses to the PCP for
  consideration in reflecting the true burden of illness. 
• Supports a variety of projects as needed when reviewing related medical records for Providers with high
  volume or opportunity. 
• Conducts pre-charting findings and orders prior to patient visit with PCP daily/weekly. 
• Reviews PCP’s documentation & coding to ensure documentation reflects the true acuity of the patient.
  Utilizes HCC analytics information to target populations for review based on level of opportunity
• Updates OPA alerts with suspected HCC opportunities based on chart review 
• Assisting in the development of HCC educational materials 
• Provide direct elbow support to clinicians on documentation best practices 
• Lead HCC educational sessions with new and returning physicians

Education

• High School Diploma/GED - minimum
• Bachelor's Degree Bachelor's Degree in Nursing or Health Information Management. - preferred

Experience

• 3 years Medicare risk adjustment coding & documentation required 
• 2 years Experience providing training information to clinical and administrative
  staff preferred  
• 3 years Experience using software such as Microsoft Office including Excel and
  PowerPoint to develop presentations preferred  
• 1 year Exposure to risk adjustment analytics platform(s) to gain insights into
  risk adjustment performance and opportunities required 

Licenses and Certifications

• Valid Clinical CA license preferred (PA, NP, LVN or RN) 
• Registered Health Information Administrator preferred 
• AHIMA or AAPC coding credential and/or registration (One or more of the following: CDIP, CDEO, CCS, CPC, CRC) required