Outpatient CDI Specialist-Hybrid

About the position This position requires the ability to build strong working relationships with Clinicians, Administrators, and Revenue Cycle colleagues. This position must possess strong communication skills to bridge and connect interrelated concepts, business functions, and processes in order to deliver results through an Outpatient CDI program. Not only will this position need to understand various payment structures, fee schedules, and reimbursement methodologies in the outpatient setting and with physician encounters, but requires knowledge of how physician documentation translates into ICD-10-CM and HCPCS/CPT codes for claims submission to meet reporting requirements. This position will be expected to create and effectively deliver presentations educating physicians, group practices and administration as well as individually track, monitor, and report on case reviews and document results achieved. This position requires skills of prioritization and organization of time and materials, which may include addressing physician documentation and education needs, demanding and competing priorities and deadlines. This position will be recognized and relied upon as a subject matter expert in how proper provider documentation drives accurate coding of outpatient services.

Responsibilities

• Build strong working relationships with Clinicians, Administrators, and Revenue Cycle colleagues.
• Possess strong communication skills to bridge and connect interrelated concepts, business functions, and processes.
• Understand various payment structures, fee schedules, and reimbursement methodologies in the outpatient setting and with physician encounters.
• Understand how physician documentation translates into ICD-10-CM and HCPCS/CPT codes for claims submission to meet reporting requirements.
• Create and effectively deliver presentations educating physicians, group practices and administration.
• Individually track, monitor, and report on case reviews and document results achieved.
• Prioritize and organize time and materials, which may include addressing physician documentation and education needs, demanding and competing priorities and deadlines.
• Serve as a subject matter expert in how proper provider documentation drives accurate coding of outpatient services.

Requirements

• Minimum of an Associate degree in a healthcare related program.
• 3 years of experience in health care, nursing, business, or finance.
• 3 years of ICD-10-CM and/or CPT/HCPCS coding knowledge.
• An applicable CDIS or HIM (coding) credentialing through ACDIS, AHIMA, and/or AAPC.
• OR An LPN or RN licensure with three years of ICD-10 and/or CPT/HCPCS coding.
• Certified Clinical Documentation Specialist - Outpatient (CCDS-O) required within three years.
• Understanding and knowledge of physician documentation requirements in a clinic, outpatient, or inpatient setting to capture patients’ acute and chronic conditions.
• Understanding how physician documentation is translated into ICD-10-CM diagnosis codes.
• Understanding how physician services and/or treatments rendered are translated into CPT codes, Level 1 or other HCPCS codes per physician or outpatient encounter.
• Understanding of the relationship between provider documentation, coded data, and CMs-1500 and UB-04 Claim reporting requirements.
• Ability to navigate in various electronic health records.