Clinical Documentation Integrity Specialist (CDIS)

The Clinical Documentation Integrity Specialist (CDIS) is a key member of firsthand’s clinical documentation team. We are looking for a scrappy, detail-obsessed individual who will ensure accurate, comprehensive, and timely clinical documentation. The CDIS will enable the best care possible for our individuals by empowering: our care teams to plan appropriate care, our support teams to identify potential population health interventions, and more.

This is a full time position. The expected workload is 40 hours per week, with flexible scheduling available in the Eastern, Central, and Mountain time zones.

As a CDIS, you will:

• Perform prospective, retrospective, and concurrent coding reviews based on evaluations of prior visit documentation, lab results, images, external medical records, payer claims data, and more
• Support pre-visit planning by communicating to firsthand providers individuals’ potential chronic conditions and care gaps with robust and appropriate evidence
• Ensure accurate, timely, and comprehensive clinical documentation to support code capture, including querying providers when these clinical documentation standards are not met
• Support medical records requests when providers require additional information prior to addressing and diagnosing potential conditions
• Work with team leadership to identify chronic condition prevalence trends by individuals’ demographics; identify and execute potential interventions, e.g., ongoing education to firsthand providers and the CDI team, ongoing quarterly retrospective reviews of unaddressed suspects

Minimum Qualifications:

• Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) from AAPC in good standing is required
• Minimum of 5 years of risk adjustment-focused medical record review and ICD-10 coding experience, specifically using the Medicare HCC model, in multiple settings (e.g., inpatient, outpatient) Fluent knowledge of ICD-10 CM Official Guidelines for Coding and Reporting, and AHA/AMA/CMS coding resources, to support audit findings
• Ability to gain proficiency in and apply productivity tools, such as spreadsheets, Google Suite, and EHR systems
• Excellent written and verbal communication skills, especially to maintain working relationships with firsthand providers (APNs, NPs), other CDISs, Medical Records Specialists, and others
• Proven experience working remotely
• Alignment to firsthand’s mission, vision and values: Demonstrate respect, dignity, empathy, and professional conduct to both individuals that firsthand serves and firsthand team members

Competencies:

• Demonstrate mastery of the Medicare HCC model, clinical coding guidelines/methodologies, and AHIMA/ACDIS ethical standards of coding; self-motivated to stay abreast of CMS rules and incorporate those changes into daily work
• Proficiency in tracking down, leveraging, and reviewing high volumes of internal and external data (e.g., medical records) to support pre-visit planning and appropriate code capture
• Self-starter with a high degree of drive, initiative, and follow through; comfortable and motivated to work in a fast-paced, ever-changing environment with a passion for problem solving
• Exceptional interpersonal, written and verbal communication skills; proven ability to collaborate across multiple teams and engage in multiple perspectives to work toward a common goal
• Query providers in an ethical manner and track compliance
• Develop CDI policies and procedures to include query process, education and training, and performance tracking
• Bonus but not necessary: familiarity with Medicaid risk models, such as CDPS or ACG