Role Description
Detail-oriented and data-savvy Clinical Documentation Improvement (CDI) Specialist. The ideal candidate will play a key role in ensuring accurate and complete clinical documentation that supports appropriate risk adjustment, ICD-10 coding integrity, and optimized reimbursement under Medicare Advantage and other value-based care programs. This role requires strong collaboration across departments and effective use of AI platforms and data tools to drive documentation excellence and compliance.
• Review patient medical records (charts) for completeness, accuracy, and compliance with ICD-10-CM coding guidelines and CMS risk adjustment criteria.
• Identify documentation gaps or opportunities that impact HCC capture and risk scores.
• Utilize AI-enabled CDI platforms, electronic health records (EHR), and data dashboards to analyze trends, prioritize chart reviews, and flag discrepancies.
• Work closely with primary care providers, specialists, and other clinical staff to clarify documentation and educate on best practices, when required.
• Collaborate with coding, billing, compliance, and analytics teams to align goals and implement CDI strategies, when required.
• Support the execution of cross-functional projects aimed at improving data integrity, documentation quality, and risk adjustment outcomes.
• Maintain accurate tracking and reporting of CDI queries, provider responses, and documentation improvements in designated systems or databases.
• Stay up to date on current CMS guidelines, ICD-10-CM updates, HCC risk adjustment models (CMS-HCC, RxHCC), and relevant healthcare regulations.
Qualifications
• Credentialed coder (CRC, CPC, CMPA or similar). Clinical background is a plus (RN, IMG).
• Minimum of 3 years of experience in clinical documentation improvement, risk adjustment, or outpatient medical coding.
• Strong understanding of ICD-10-CM coding, HCC coding principles, V28 risk model and Medicare Advantage documentation requirements.
• Experience working with AI-based CDI platforms, EHR systems, and healthcare data tools.
• Excellent communication, critical thinking, and problem-solving skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Bilingual (English/Spanish) is a plus.
Requirements
• Innovacare participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.