Outpatient Clinical Documentation Improvement Specialist (Remote)

About CorroHealth

Our mission is to empower clients in surpassing their financial health objectives. Leveraging advanced analytics and clinical expertise, we provide scalable solutions that address programmatic challenges throughout the reimbursement cycle. By equipping our teams with state-of-the-art technology, we ensure accountability and successful achievement of goals.

We are committed to fostering long-term career growth through investment in your professional development and personal advancement, recognizing that your success fuels our own.

Job Overview

The Outpatient Clinical Documentation Improvement (CDI) Specialist will work closely with physicians, nursing personnel, caregiving staff, and medical coding teams to enhance the quality, accuracy, and completeness of clinical documentation. This role focuses on reviewing outpatient medical records for opportunities to clarify diagnoses, validate documentation concerning Diagnosis-Related Group (DRG) assignments, severity of illness, risk of mortality, and case mix data. CDI Specialists will ensure timely and precise clinical documentation supporting effective physician and facility outcome measurement by employing comprehensive chart reviews and queries aligning with AHIMA standards and CorroHealth protocols.

Key Responsibilities

• Analyze outpatient encounters, including pre-visit, concurrent, and post-visit documentation, to confirm accuracy and thoroughness.
• Identify documentation improvement areas related to chronic illnesses, disease specificity, risk adjustment factors (such as Hierarchical Condition Categories - HCCs), quality metrics, and medical necessity.
• Issue compliant clarification queries and provide constructive feedback to healthcare providers using approved communication pathways.
• Support effective management of problem lists and ongoing validation of clinical conditions.
• Collaborate across coding, quality assurance, compliance, and revenue cycle departments as required.
• Monitor, record, and report CDI intervention trends and outcomes; actively participate in provider education and training programs.
• Maintain up-to-date knowledge of outpatient coding regulations, risk adjustment protocols, and regulatory standards.
• Ensure adherence to CMS, payer, and organizational guidelines for documentation and billing compliance.
• Identify potential compliance risks such as over-coding, under-coding, and unsupported diagnoses applying comprehensive knowledge of HCCs, risk adjustment, quality measures, and outpatient reimbursement methods.

Qualifications

• Possession of an active coding credential such as RHIA, RHIT, CPC, COC, CCS-O, CCS, CDEO, CCDS, CDIP, or CCDS-O.
• Minimum of 3 years’ experience in outpatient coding, risk adjustment, or outpatient CDI roles.
• In-depth understanding of ICD-10-CM outpatient coding standards, risk adjustment models (e.g., Medicare Advantage HCCs), and outpatient Evaluation and Management (E/M) documentation requirements.
• Experience with ambulatory Electronic Health Records (EHR) systems including Epic, Cerner, or equivalents.
• Proficiency in professional fee multi-specialty coding.

Skills and Competencies

• Strong clinical knowledge paired with analytical decision-making abilities.
• Professional and effective communication skills.
• Excellent written documentation proficiency and the ability to work independently within a dynamic environment.
• Advanced skills in Microsoft Office applications.

Preferred Qualifications

• Experience with telecommuting and working with electronic medical records and digital tools.
• Robust analytical abilities and numerical aptitude.
• Collaborative team player comfortable managing multiple diverse projects and clients.
• Ability to operate autonomously with minimal supervision ensuring high accuracy and attention to detail.
• Competency in maintaining and accessing multiple electronic files efficiently.

Work Environment and Physical Requirements

This role is fully remote. Reasonable accommodations can be made to support individuals with disabilities. Prolonged computer use requiring coordinated eye-hand movements and manual dexterity is necessary. The position includes periods of extended sitting and occasional lifting of items up to 20 pounds. The role may entail functioning under stress during busy periods or approaching multiple deadlines.

Additional Information

This job description outlines the primary functions and responsibilities expected but is not exhaustive. Duties and competencies may be adjusted by leadership to fit operational needs.