Clinical Documentation Improvement Partner

Who You Are

You are devoted and compassionate, and enjoy being on the front lines of healthcare, changing the lives of your patients. You believe patients living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You don’t want to sacrifice quality over quantity, and you aim to provide the same level of care and commitment to your patients that you would to your own family member. You thrive in innovative and evolving environments with high rates of change. You are driven by process improvements. 

Who We Are

Evergreen Nephrology partners with nephrologists and other providers to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe people living with kidney disease deserve the best care. We are committed to improving patient outcomes and quality of life by delaying disease progression, engaging patients in their own care, optimizing care delivery and transitions, and accelerating kidney transplants through partnerships with our nephrologists and other providers, best-in-class interdisciplinary clinical resources, and technology and analytics platform that enables optimized insights and care.

Your Role

The Clinical Documentation Improvement Partner is responsible for partnering with physician offices within our established partnerships to assist 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.

Primary Functions

• Accurately code diagnoses based on documented information, ensuring compliance with regulatory requirements and that the assigned codes accurately represent the clinical information documented by the provider
• Ensure documentation supports appropriate level(s) of care and severity of illness when applying ICD-10, CPT, and other relevant codes for billing and regulatory compliance
• Maintain a 95% productivity rate
• Communicate with physicians and other healthcare providers to clarify documentation, ensuring that diagnoses and procedures are properly documented in compliance with clinical standards
• Issue queries to healthcare providers when documentation appears ambiguous, incomplete, or inconsistent, requesting clarification or additional details be added to the medical record to ensure accurate documentation
• Ensure that the queries are compliant with industry standards and regulatory guidelines
• 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 to support various quality initiatives, such as HEDIS, CMS, and other contractual or enterprise-initiated performance metrics
• Participate in performance improvement projects aimed at improving documentation practices and outcomes
• Conduct audits of medical records to identify trends in documentation, both positive and negative, to help the organization improve documentation practices and provider education efforts
• Provide ongoing education to clinical staff, coders, and other healthcare providers on best practices in clinical documentation, coding guidelines, and regulatory compliance
• Develop training programs to address documentation deficiencies and improve overall documentation quality
• Collaborate with departments such as compliance, revenue cycle, and quality management to optimize the documentation improvement process

Required Qualifications

• High school diploma, GED, or suitable equivalent
• 2+ years recent outpatient medical coding experience
• Must possess one of the following coding credentials: CPC, CRC, CCS, or similar
• Strong knowledge of ICD-10-CM, Category II and CPT coding
• 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 Categories (HCC)
• Ability to analyze complex medical records, identify documentation gaps, and determine appropriate queries
• Strong written and verbal communication skills
• Meticulous attention to detail that ensures a high level of accuracy in your work product
• Ability to identify discrepancies in clinical documentation and partner with providers to resolve issues efficiently.
• Familiarity with electronic health rec