Clinical Documentation Improvement Specialist

Job Description Summary ‎ Responsible for conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment. ‎ How will you make an impact & Requirements ‎ Location: Candidate must reside in the city of Los Angeles, Los Angeles county or Orange county. This is a hybrid role with the need to travel to multiple locations 2 days per week, while being able to work from home 3 days per week. Responsible for conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment. Primary duties include, but are not limited to: 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 looking at both ways 1) appropriate detail in the medical record is not captured in what is reported, and 2) when reported information is not supported by details in the medical record. 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) including the use of appropriate modifiers for HEDIS scoring accuracy. Conducts on-going review of medical records/practice notes to validate improvement, identify any new/additional opportunities to improve medical record-keeping, code more accurately, ensure on-going accuracy of submitted codes and accurate risk scoring and continues to verify coding accuracy and completeness to 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. Compensation: $90,160K - $112,700K & bonus eligible ‎ Beware of fraudulent job postings: While Mosaic Health job advertisements may be found on many sites, our current openings page and its associated Workday account are the only places we accept applications for open roles. If you suspect a job post is fraudulent, please let us know at recruiting@apree.health. Mosaic Health 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. Learn More about Mosaic Health Learn more about apree health Learn more about Carelon Health Learn more about Elevance Health