p>The Clinical Documentation Integrity Specialist (CDIS) Lead is an advanced level position for the experienced and proficient CDI Specialist consistently meeting or exceeding all criteria for CDIS advanced performance, with an additional emphasis on management responsibilities and expanded scope of oversight. EDUCATION: Licensed Registered Nurse, RHIA, RHIT, CCS, CDIP, CCDS, or other qualified Clinical Documentation Integrity professional required. The Risk Adjustment Strategic Manager is responsible for overseeing the day-to-day operations and strategic execution of enterprise risk adjustment programs, including prospective and retrospective initiatives, provider engagement and education, data submissions, vendor oversight, and audit readiness. This role serves as a strategic partner to business leadership by driving operational excellence, ensuring compliance with Centers for Medicare & Medicaid Services (CMS) requirements, and supporting initiatives that optimize revenue integrity and program performance. p>The Clinical Documentation Integrity Specialist (CDIS) Lead is an advanced level position for the experienced and proficient CDI Specialist consistently meeting or exceeding all criteria for CDIS advanced performance, with an additional emphasis on management responsibilities and expanded scope of oversight. EDUCATION: Licensed Registered Nurse, RHIA, RHIT, CCS, CDIP, CCDS, or other qualified Clinical Documentation Integrity professional required. Job Summary: The Clinical Documentation Integrity Specialist (CDIS) Lead is an advanced level position for the experienced and proficient CDI Specialist consistently meeting or exceeding all criteria for CDIS advanced performance, with an additional emphasis on management responsibilities and expanded scope of oversight. Work Experience, Education and Certifications: EDUCATION: Licensed Registered Nurse, RHIA, RHIT, CCS, CDIP, CCDS, or other qualified Clinical Documentation Integrity professional required. p>• Registered Nurse with active license, unrestricted license • Bachelor of Science in Nursing from an accredited college/university • Substantial clinical experience with demonstrated ability to interpret clinical documentation and medical necessity • Certified Professional Coder (CPC) with coding experience across inpatient, outpatient, and professional services • Familiar with the revenue cycle process and facility and professional claims • Demonstrates excellent communication skills, both written and oral • Experience managing small projects and teams • Familiar with accessing and identifying clinical documentation in electronic medical record systems • Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings • Ability to problem solve, multi-task, and prioritize assignments • Understands the importance of privileged and confidential communication • Willingness to travel when needed • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. The Outpatient Coder shall review hospital outpatient medical documentation or physician medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, CPT and HCPCS codes with outpatient encounters to ensure proper coding, billing and compliance. Reviews encounter to assign and sequence appropriate diagnoses and/or procedure codes as well as modifiers to diagnostic, physician and/or surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures. Job Summary: The Outpatient Coder shall review hospital outpatient medical documentation or physician medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, CPT and HCPCS codes with outpatient encounters to ensure proper coding, billing and compliance. Reviews encounter to assign and sequence appropriate diagnoses and/or procedure codes as well as modifiers to diagnostic, physician and/or surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures. p>Position Qualifications: Responsibilities: Certifications: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician - American Health Information Management Association (AHIMA), Certified Outpatient Coder - American Academy of Professional Coders, Certified Professional Coder - Outpatient - American Academy of Professional Coders, Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA). Demonstrate advanced knowledge and expertise in professional and outpatient facility coding practices; provide guidance and support to coding staff on complex coding scenarios and regulatory requirements; stay updated on changes in coding regulations and guidelines to maintain subject matter expertise. Duties may be varied and may include many of the following: Organize work schedules Create work assignments Review timecards for accuracy Conduct quality assurance audits of staff performance Develop and implement quality improvement activities Train and mentor staff Provide feedback on staff performance and developmental needs Collect/analyze/report on data Prepare reports on performance and metrics And other responsibilities of a similar nature and level. At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based upon documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. |
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