The Clinical Documentation Improvement Specialist (CDI Specialist) is responsible for performing medical documentation assessments to identify opportunities for improvement to ensure documentation is accurate and complete, and supports medical necessity of codes reported. The CDI Specialist will have the ability to communicate effectively in order to educate providers on clinical documentation guidelines.
- Certification as a medical coder or medical auditor is required
- 2+ years of medical coding experience in outpatient office setting
- Strong knowledge of physician documentation guidelines, with emphasis on Evaluation and Management documentation and coding
- Strong knowledge of CPT and ICD-10 codes
- Strong knowledge of Medicare, Medicaid and commercial payor requirements
- Strong knowledge of disease processes (e.g. severity of disease, Pathophysiology, co-morbidities)
- High school diploma required
- Strong computer skills
- Proficient with Microsoft Office (Excel, Word and Power Point)
- Excellent oral and written communication skills
- Critical thinking skills
- Must be able to work onsite
- Review medical records for completeness, accuracy and compliance with regulations
- Document audit findings using Microsoft Excel or assigned auditing tool
- Formulate recommendations based upon the audit findings
- May assist in educating providers on clinical documentation guidelines
- Review CPT and ICD-10 code updates annually, ICD-10 in October each year and CPT-4 in January each year.
- Consistently review newsletters, periodicals and other publications from CMS, AMA, AHA, AHIMA, AAPC and payors for coding updates, documentation guideline changes and payor specific guidelines.
- Provide education to providers, office managers, billers and collectors as needed.
- Assists billing and collections with coding and documentation questions.
- Assists in preparing letter of response to insurance companies about incorrect payment and dispute resolution.
Job Type: Full-time
Salary: $21.63 to $23.00 /hour
- Certified Medical Coding: 2 years
- High school or equivalent