WHO YOU ARE

You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Does this sound like you? If so, we should talk.

WHO WE ARE

Evergreen Nephrology partners with nephrologists to transform kidney care through a value- based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.

We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.

We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

Your Role

As a Clinical Documentation Improvement Partner, you will partner with physician practices within our established partnerships to facilitate documentation improvement strategies and regulatory compliance. You will assist them in translating healthcare documentation into standardized codes, ensuring accurate coding and billing of patient encounters, as supported by the medical record. You serve as a subject matter expert in coding and documentation improvement and do not shy away from hard discussions with providers. You advise and educate physicians and other professional clinical staff on coding and documentation best practices and regulatory compliance and thrive in a fast-paced environment with minimal oversight, making important decisions for both Evergreen and our partners.

Primary Functions

• Review physician practice partners’ diagnosis codes for accuracy based on documented information, ensuring compliance with regulatory requirements and that the assigned codes accurately represent the clinical information documented by the provider.
• Ensure that documentation supports appropriate level(s) of care and severity of illness when applying ICD-10, CPT, and other relevant codes for billing and regulatory
• Maintain a 95% productivity rate
• Engage and partner with physicians and other healthcare providers to clarify documentation and confirm that diagnoses and procedures are properly documented in compliance with applicable clinical standards, while also advising on improvement
• Determine when provider claims must be withheld or withdrawn and professionally engaging with partner practices to align on improvement efforts and compliance
• Stay updated on current coding guidelines, clinical protocols, and regulatory changes, including Medicare and Medicaid guidelines on billing and coding, to support provider compliance therewith.
• Assist in improving the quality of clinical documentation enterprise-wide and with our physician practice partners to support various quality initiatives, such as HEDIS, CMS, and other contractual or enterprise-initiated performance metrics.
• Create and implement performance improvement projects aimed at improving documentation practices and outcomes.
• Audit medical records to identify trends in documentation, both positive and negative, to improve documentation practices and provider education efforts.
• Develop and provide ongoing education to clinical staff, coders, and other healthcare providers on best practices in clinical documentation, coding guidelines, and regulatory
• Develop individualized training programs to address documentation deficiencies and improve overall documentation quality.
• Collaborate with other departments such as compliance, revenue cycle, and quality management to optimize the documentation improvement process.
• Other duties as reasonably

How You Qualify

• Strong knowledge of ICD-10-CM, Category II and CPT
• Proficiency in medical terminology, anatomy, and physiology.
• Familiarity with healthcare laws, regulations, and other applicable guidance, such as Medicare, Medicaid, HEDIS, and CMS performance measures.
• Knowledge of risk adjustment methodology and Hierarchical Condition Cat