Clinical Documentation Improvement Specialist

Health Choice NetworkHealthcare risk adjustment

Source API remote eligibility restrictions: United States; 100% Remote Work – Work from anywhere within the United States.Full-TimeMiddle

Salary70,000 - 85,000 USD per year

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Job Details

Experience: Minimum of 3 years of experience in Medicare and/or Medicaid Risk Adjustment, including HHS-HCC, CMS-HCC, or DxCG methodologies.

Associate degree required; Bachelor's degree preferred.
Hold Certified Risk Coder (CRC) certification through AAPC or CDI/CCS certification through AHIMA.
Have at least 3 years of experience in Medicare and/or Medicaid Risk Adjustment, including HHS-HCC, CMS-HCC, or DxCG methodologies.
Have strong experience with ICD-10 coding and clinical documentation review.
Have in-depth knowledge of medical terminology, anatomy, physiology, and disease processes.
Have expertise in HCC coding and risk adjustment programs.
Bring strong analytical, organizational, and problem-solving skills.
Have written and verbal communication skills and the ability to educate audiences at all levels.
Be able to manage multiple priorities and work independently in a remote environment.
Preferred: current RN license in good standing.
Preferred: Certified Professional Coder (CPC) certification through AAPC.
Preferred: at least 3 years of clinical experience, preferably in a Federally Qualified Health Center (FQHC) or primary care environment.
Preferred: experience with Epic Electronic Medical Record (EMR) systems and supporting value-based care and population health initiatives.

Serve as a subject matter expert on ICD-10-CM Coding Guidelines, AHA Coding Clinic guidance, and risk adjustment methodologies.
Conduct proactive medical record reviews to assess documentation quality, diagnosis coding accuracy, co-morbidities, complications, and secondary diagnoses.
Identify documentation and coding trends affecting patient risk scores and value-based care performance.
Develop and deliver education programs for providers, coders, and clinical care teams.
Provide guidance on documentation practices, coding updates, compliance requirements, and risk adjustment principles.
Create educational tools, resources, and training materials to improve coding accuracy and documentation quality.
Collaborate with contracted health plans on risk adjustment and value-based care initiatives.
Support audits, review health-plan findings, and develop performance improvement plans when needed.
Analyze documentation and coding trends and work with clinical leadership, coding teams, health plans, and operational stakeholders to identify improvements.

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