Clinical Documentation Improvement Specialist

February 21

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

💵 $79.4k - $119.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

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Mosaic

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Mosaic is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.

residential • vocational • medical • spiritual • social

1001 - 5000 employees

Founded 1913

⚕️ Healthcare Insurance

💳 Fintech

👥 B2C

📋 Description

• Responsible for conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment. • Conducts retrospective medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures. • Verifies accuracy/appropriateness of submitted diagnosis codes based on medical record documentation. • Identifies and recommends coding best practices to address unsupported additions/deletions, inconsistencies/discrepancies. • Updates and develops policies and procedures and training/educating collateral to reflect best practices. • Conducts on-going review, monitoring and communications to promote and ensure adherence to established protocols and best practices. • Reviews documentation of well visits (annual well visits and other routine and preventative visits). • Conducts on-going review of medical records/practice notes to validate improvement and ensure compliance.

🎯 Requirements

• Requires minimum of 2 years experience coding all types of medical records (including Medicare Risk Adjustment) in a physician practice setting or large group practice. • Current Certified Professional Coder certification (CPC, CPC-H, CCS, or CCS-P) required. • Additional experience in procedural clinical coding preferred. • Clinical experience or background (e.g. RN, LPN, foreign medical graduates) preferred. • For the Carelon Health business unit only, requires a minimum of 2 years’ experience with all types of medical records (including Medicare Risk Adjustment and evaluation and management coding) in a physician practice setting or large group practice, includes educating providers on clinical documentation needs. • Certified Clinical Documentation Specialist (CCDS, CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Improvement Professional (CDIP) required. • Current Certified Professional Coder certification (CPC, CPC-H, CCS, CCS-P or CRC) preferred. • Additional experience in diagnostic clinical coding preferred. • Clinical experience or background (e.g. RN, LPN, foreign medical graduates) preferred. • Travels to worksite and other locations as necessary.