Overview We at M Health Fairview are looking for a Remote Outpatient Clinical Documentation Integrity (CDI) Specialist to join our team! This is a fully remote position that is approved for a 1.0 FTE (80 hours per pay period), Monday - Friday, 8am - 4:30pm CST. As an Outpatient CDI, you will play a critical role in creating a culture of best-in-class clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. You will work closely with our Population Health, Clinical, and Compliance teams to participate in our Clinical Documentation Integrity program and leverage your clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. Outpatient CDI performs clinically based health record reviews to facilitate and obtain appropriate provider documentation for clinical conditions and procedures to reflect severity of illness, risk adjustment, accurate coding, accuracy of patient outcomes, and complexity of patient care. This includes accurate documentation to support the capture of Hierarchical Condition Categories (HCCs), ICD-10-CM specificity, and CPT/HCPCS codes in outpatient visits. Outpatient CDI review a variety of outpatient settings including, but not limited to provider offices, hospital-based clinics, ambulatory surgery, observations, and emergency departments. Through compliant query processes and education, clarifies incomplete, conflicting, ambiguous, and/or missing provider documentation. The Outpatient CDI work in collaboration with other CDI specialists, coders, quality, providers, and other members of the healthcare team to ensure accurate, high-quality clinical documentation to support MHealth Fairview initiatives. The Outpatient CDI functions as a resource and educates members of the patient care team, both formally and informally, regarding the impact of documentation on patient care, quality metrics, risk adjustment, and correct reimbursement. Adheres to departmental and organizational goals, objectives, standards of performance, policies, and procedures, continually ensuring quality documentation and regulatory compliance. Responsibilities Job Description Job Expectations: In collaboration with the providers and staff, identifies first listed diagnosis, secondary diagnoses, pertinent HCCs, outpatient procedures, and documentation completeness in the outpatient/ambulatory setting. Facilitate appropriate clinical documentation through prospective, concurrent, and retrospective medical record review. Ensures accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes. Performs thorough and timely medical record reviews to identify potential gaps or opportunities to facilitate improved provider documentation. Maintain competence related to HCC documentation requirements, ICD-10-CM code assignment, coding guidelines, conventions, and coding clinics. Demonstrates thorough understanding of various payment structures, fee schedules, and reimbursement methodologies in the outpatient setting, including physician encounters and how physician documentation translates into ICD-10-CM and HCC risk adjustment for claims submission to meet reporting requirements. Ensures clinical documentation accurately reflects the level of care rendered, severity of illness, risk of mortality, and supports clinical validation (in compliance with government and other regulations). Recognizes opportunities for documentation improvement using strong critical-thinking skills and sound judgment in decision making, keeping integrity and compliance at the forefront of considerations in addition to outcomes, reimbursement, and regulatory requirements. Facilitates high-quality documentation by utilizing queries that are effective, clear, concise, and compliant in accordance with latest AHIMA/ACDIS Query Practice Brief and white paper guidance. Provides information and ongoing education, as necessary, to providers and staff on documentation issues, guidelines, and unanswered queries. Promotes compliance with CMS, Medicare documentation, and coding and billing regulations. Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative levels. Collaborates with the Population Health Department to ensure documentation meets quality initiative standards used for measuring and reporting ACO and provider outcomes. Collects, analyzes, and submits timely, accurate and complete reports of clinical documentation information used for measuring and reporting ACO and Provider outcomes data. Participates in the education of new team members concerning clinical documentation integrity guidelines and processes. This may include providers, CDIs, coders, and other healthcare providers. Works with the Coding teams on any issues that arise concerning documentation, providers, and queries to enhance the concurrent process to enable prompt coding. May provide educational support in terms of clinical/coding or process at manager’s discretion and as need arises. Demonstrates willingness to learn and accepts feedback productively. Meets and maintains CDI quality, productivity, and query compliance standards per policy. Works independently; demonstrates effective time management and prioritization of tasks. Perform duties and conducts interpersonal relationships in a manner that promotes a team approach and collaborative work environment with physicians, CDI staff and coders. Assumes responsibility for professional development through participation at workshops, conferences, and/or in-services and maintains appropriate records of participation. Complies with and ensures adherence to HIPAA and Code of Conduct policies. Support and assist Coding staff during back-logs. Performs other job-related duties as assigned Develops Strong Work Relationships: Participates in work with peers and other departments to create an excellent understanding of workflows and interdependencies, and to identify and implement strategies to improve revenue cycle performance. Works collaboratively with vendors to assure performance expectations are being met as necessary. Represent Revenue Cycle and Fairview Health Services at industry forums to network and identify process improvement opportunities. Serves as a resource on revenue cycle issues and regulatory expectations. Creates strong collaborative partnerships and influence others across teams, groups and business boundaries to achieve real world problem solving Organization Expectations, as applicable: Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served. Communicates in a respective manner. Ensures a safe, secure environment. Modifies clinical interventions based on population served. Fulfills all organizational requirements. Completes all required learning relevant to the role. Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures, and standards. Fosters a culture of improvement, efficiency, and innovative thinking. Performs other duties as assigned. Qualifications Required Education Associate degree in HIM, or equivalent healthcare coding experience. Required Experience At least 2-3 years coding experience required; or a combination of 1-2 years coding experience and HCC Capture, Risk Adjustment or Outpatient CDI experience. Demonstrated extensive critical-thinking skills, and understanding of disease processes, anatomy, pathophysiology, and disease management/treatment required. Demonstrated knowledge of current coding guidelines and methodologies: HCCs, ICD-10-CM coding guidelines, clinics, and conventions required Required License/Certification: Outpatient or Professional Fee Coding: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Coding Specialist - Professional (CCS-P), Certified Professional Coder - Hospital (CPC-H), Certified Clinical Documentation Specialist-Outpatient (CCDS-O), Certified Risk Adjustment Coder (CRC) Additional Requirements: Proficiency with Microsoft Office (Teams, Excel, PowerPoint, Word, Outlook) required. Proficiency with electronic medical record (EMR) required. Epic preferred. Proficiency with coding technology systems preferred. Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers. Expert knowledge of ICD-10 and CPT and related coding/abstracting rules and guidelines Expert knowledge of medical terminology, anatomy, physiology, and pathophysiology Expert knowledge of relationships of disease management, medications and ancillary test results on diagnoses assigned Proficiency with computer systems, including electronic health record Critical thinking and problem-solving skills Highly effective written and verbal communication skills Ability to prepare educational materials for coding staff and providers Ability to accept cultural differences Preferred Education Bachelor’s degree in HIM or higher Preferred Experience: 4-5 years of relevant coding experience; or a combination of 3+ years coding experience and HCC Capture, Risk Adjustment or Outpatient CDI experience. Prior clinical documentation integrity (CDI) experience Preferred License/Certification/Registration Outpatient or Professional Fee Coding: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Coding Specialist - Professional (CCS-P), Certified Professional Coder - Hospital (CPC-H), Certified Clinical Documentation Specialist-Outpatient (CCDS-O), Certified Risk Adjustment Coder (CRC) EEO Statement EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status Benefit Overview Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract Compensation Disclaimer The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical.