Clinical Documentation Improvement Specialist

Clinical Documentation Improvement Specialist
Remote

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

POSITION SUMMARY:

As a Clinical Documentation Improvement Specialist, you will be a vital member of the team responsible for ensuring accurate clinical suspected conditions are properly curated in the compendium for the provider/patient visit. The primary goal of the Prospective Risk Clinical Coder with in Reveleer, is to validate the results of our prospective suspecting NLP technology, presented by our platform, and ensure the accurate curation of codes and level of specificity found to be clinically evident are presented to the provider in the compendium prior to the encounter. In this position the ideal candidate will evaluate clinical information from a myriad of digital sources, including electronic health records, health information exchanges, claims encounter systems for accuracy and conciseness. This individual will apply clinical coding knowledge, AHA coding clinic guidelines and prospective risk strategies to ensure accurate information is delivered to the provider at point of care.

ESSENTIAL FUNCTIONS:

• Clinical Documentation Review: Analyze medical records and NLP results and validate that the suspected HCC and the clinical evidence meets the necessary requirements for submission and documentation. This includes making sure the documentation accurately reflects the patient’s conditions, treatment and services provided. Identify gaps, inconsistencies, and discrepancies in documentation that could impact patient care, quality reporting and reimbursement.
• Provider Feedback: Provide documentation and feedback to healthcare providers on required documentation for suspected HCC’s.
• Coding Support: Ensure documentation aligns with accurate code assignment and follow CMS’s coding guidelines for HCC risk adjustment coding.
• Regulatory Compliance: Stay up-to-date with healthcare regulations, guidelines and standards such as ICD-10 codes, HCC mapping models to ensure documentation compliance with legal and regulatory requirements.
• Clinical Knowledge: Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation.
• Documentation Integrity: Safeguard the integrity and confidentiality of patient health information while handling medical records and sensitive data in accordance with HIPAA and other relevant regulations.
• Interdisciplinary Communication: Foster clear communication and collaboration between different healthcare departments, ensuring that accurate patient information is shared across the continuum.

KEY METRICS:

• Coding and Documentation Quality
• Productivity

CORE COMPETENCIES:

• Caring – Warm, sincere, calm, cool and collected energy and presence with the ability to develop relationships.
• Results Driven – Focus on achievement, motivated by results and outcomes, goal oriented.
• Analytical Skills and Attention to Detail– Reviewing clinical documentation and coding.
• Effectively Communicates – Speaks clearly, listens effectively, and responds well to questions; Writes clearly and informatively; Edits work for errors; Varies writing style to meet needs; Able to read and interpret information; Documents are accurate and delivered on time; Uses good judgement when communicating information.
• Problem Solver - Expertise managing client relationships and accounts for technically complex products and platforms with the ability to lead a resolution towards mutual success.
• Continuous Quality Improvement – Evaluates polices, programs, and services; Implements strategies for continuous quality improvement; Assesses the use of evaluation findings for improving policies, programs,