The CDI Specialist will have a broad clinical knowledge base and understanding of Risk Adjustment documentation and coding requirements with experience in the Medicare Advantage market. The CDI Specialist may contribute to content development, ongoing service line documentation improvement initiates (including formal and informal provider education), pre-and post-encounter documentation and coding reviews, and participate in department and organization projects related to Risk Adjustment activities. Will facilitate, obtain and review appropriate provider documentation for clinical conditions to support the appropriate severity of illness, accuracy of ICD reporting and supporting language and perform CDI QA reviews: Prospective, Concurrent, Pre-bill, and Retrospective. Also, serve as an expert resource in reviewing all medical records in support of consistent documentation for all payer types (i.e. CMS, Medicare-Advantage, etc.) to ensure complete and accurate diagnosis capture and coding; educate providers, nurses, coders, and other disciplines on documentation, coding, and reimbursement issues.

The CDI Specialist will identify quality issues in documentation and seek resolution of issues through appropriate channels; conduct data and root cause analysis, provides feedback, and shares findings on the analysis to leaders, management, and medical teams. Will work independently the majority of the time with a high degree of autonomy.

Qualifications

High school diploma or GED equivalent required.

Minimum of 5 years ICD-10 coding

Experience in coding for risk adjustment (Prospective Review, Retrospective Review, RADV)

Strong Knowledge of CMS HCC model

Strong communication skills, both written and verbal

Successful completion of Stanford background screening and hiring process

Successful completion of client screening exam(s) with a passing score

CRC and CPC required; RHIA, RHIT, CCS preferred.