- Serve as a subject matter expert in clinical documentation quality, risk adjustment, and HCC coding integrity in the outpatient setting.
- Perform prospective reviews of medical records from physician practices, outpatient settings, and relevant inpatient encounters to validate chronic conditions and ensure documentation accuracy.
- Utilize Epic and OurPractice Advisories (OPAs) to perform prospective chart reviews and identify documentation opportunities.
- Track and manage work queues, review inventories, and OPA-related activities to ensure timely follow-up and productivity targets.
- Monitor, analyze, and report CDI outcomes, documentation trends, and HCC recapture performance to identify improvement opportunities.