Outpatient CDI Specialist (Fully Remote)

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

This position is a fully remote position.

The remote Outpatient Clinical Documentation Integrity (CDI) Specialist is responsible for conducting outpatient medical record reviews to facilitate precise accurate complete high quality health record documentation that embodies the severity of illness risk of mortality and the quality of the care provided; ultimately resulting in accurate coding and reporting. The primary method utilized to accomplish this is through comprehensive medical record review and identification of opportunities and risk to improve documentation to promote coding to the highest level of specificity and to promote education of such to providers.

• Conducts comprehensive concurrent and retrospective outpatient reviews of medical records for assigned patients in the time frame frequency and prioritization as defined for the CDI team

• Identifies opportunities to clarify missing ambiguous or conflicting documentation and/or to validate diagnoses and CPT in the medical record. Identify areas of opportunity as related to risk adjustment.

• Applies critical thinking and clinical concepts including knowledge of medical terminology anatomy physiology microbiology pharmacology and disease process to health record reviews. Has a good working knowledge of E/M and Surgical CPT coding.

• Understands the guiding principles of clinical validation payer policy and root cause analysis of denial trends.

• Prepares a compliant written report based on outpatient documentation review.

• Demonstrates understanding of CPT ICD-10 HCPCS HCC models along with how to support recommendation with Official Source references which include AMA knowledge base and CPT assistant.

• Ability to appropriately apply and use facility-specific approved clinical indicators for specified diagnoses.

• Ability to identify process improvements in query opportunities HCC risk adjustment opportunities documentation improvement in surgical operative reports and evaluation/management.

• Perform other duties as assigned

• Comply with HIPAA and code of conduct policies

What You Will Need:

• At least one of the following: CPC CDEO or CPMA; will consider CCS-P in place of CPC with sufficient physician review experience.

• Must maintain credential while employed

• At least 3 years CDI experience (documentation review and physician education)

• Familiarity with encoder CPT ICD-10 and Risk Adjustment assignment

• Demonstrates critical thinking analytical skills and ability to resolve problems

• Maintains current working knowledge of Official Coding Guidelines and Coding Clinics

• Strong knowledge of medical terminology anatomy physiology microbiology and disease process

• Excellent communication skills employing tact and effectiveness

• Ability to converse with physicians in sometimes difficult scenarios

• Strong typing and computer skills; proficiency with EHR systems CDI software systems and encoder

What Would Be Nice to Have:

• Certification in Clinical Documentation Improvement (CCDS or CDIP) preferred

• LPN and RN credential with sufficient in OP CDI experience

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Fully Remote

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What We Offer:

Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical Rx Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.