Clinical Documentation Improvement Reviewer

Role Description

Clinical Documentation Improvement Reviewer

Associate III – BPM

Who We Are

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.

You Are

The Clinical Documentation Improvement Reviewer performs concurrent medical record reviews to ensure that all conditions reported by the provider reflect the severity of illness of the patient. This position is responsible for the validation of diagnosis codes in CDI and the identification of missing diagnosis so that patient severity of illness is properly reflected in the medical record.

The Opportunity

• Conducts an extensive analysis of patient records to evaluate documentation of HCC diagnoses.
• Obtains and promotes appropriate clinical documentation through extensive interaction with physicians (via queries) to ensure that the documentation of HCC codes is accurate.
• Reviews medical records to ensure that diagnoses are reported in accordance with CMS and ICD coding documentation guidelines.
• Maintains working relationships with medical directors and practice engagement coordinators. Compiles data to determine areas of coding documentation improvement for physician and staff training.
• Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
• Performs on-site or electronic medical record reviews to ensure capture of all relevant diagnosis is based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
  
  

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

• High School degree or GED equivalent required.
• Bachelors degree in a related field preferred. Successful completion of a coding license or certificates; Credentialed Coder Certificate/License (CPC, CRC, CPMA, or CCS-P) required.
• Continuous learning, as defined by the Companys learning philosophy, is required.
• Minimum of two (2) years of HCC specific coding experience required.
• One (1) year experience creating physician queries preferred.
• Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements. Initial demonstration and maintenance of continuing education/membership is required.
• Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes.
• Excellent organization and problem-solving skills.Strong oral and written communication skills.
• Parameter Extensive knowledge of ICD-10CM coding guidelines.
• Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint) as demonstrated through successful completion of skills test.
• Demonstrated ability to utilize a variety of electronic medical records systems.
• Ability to manage a significant work load, and to work efficiently under pressure, while meeting established deadlines with minimal supervision.
• Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.
• Strong time management skills.
• Must possess a high degree of accuracy, efficiency, and dependability.
• Excellent written and oral communication for representation of clear and concise results.
  
  

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $55,000-$77,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.

What We Believe

We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.

Humility

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity

Through business, we will better the lives of those less fortunate than ourselves.

Integrity

We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#Healthproof

#CB

Skills

Clinical Operations,Pathology,Problem Solving,Communication