Review denied claims and prepare appeal letters using clinical evidence. Collaborate with clinical staff to enhance documentation and reduce denials, while tracking denial data to recommend process improvements and ensure compliance with regulations.

• Work closely with the Everest project team members assigned to the project to achieve project milestones according to the project timeline. • Perform Everest internal QC procedures for clinical documents developed by other Medical Writers, such as clinical study protocols, Clinical Study Reports (CSRs; full, abbreviated, or synoptic), pharmacokinetic (PK) reports, statistical reports, integrated efficacy or safety summaries, patient narratives, manuscripts, posters, and abstracts. • Apply therapeutic area experience and scientific knowledge in the review and include QC checks for protocol-related information, accuracy of in-text numbers and source references, and consistency of document styles and formats. • Act as a lead medical writer in the preparation of clinical documents or scientific publications. • Perform literature searches to support senior medical writers. • Document publishing activities include, but are not limited to the following: Rendering the completed final Word report to PDF. • Plan and manage deliverables and timelines in accordance with clinical trial project teams’ requirements.

Role Description We are seeking a highly motivated and detail-oriented individual to join our team as a Clinical Documentation Improvement (CDI) Specialist. The primary responsibility of this role is to conduct thorough patient chart reviews to identify opportunities for providers to capture risk adjustment diagnostic codes accurately. The successful candidate will play a crucial role in ensuring proper documentation to support appropriate and accurate disease capture and documentation by Bluestone providers. This position offers remote flexibility and the opportunity to make a meaningful impact on documentation accuracy and comprehensive disease capture for Bluestone providers. If you are passionate about improving coding practices and ensuring quality patient care, we encourage you to apply! Schedule: Full-time, weekdays during regular business hours, no evenings, weekends or holidays. Location: This remote role MUST be located in one of the Bluestone Markets (Minnesota, Wisconsin or Florida). Salary: $60,000 – $75,000 annual salary. Salary will be commensurate with experience. Responsibilities: - Perform comprehensive reviews of patient charts to identify gaps in documentation and opportunities for risk adjustment coding improvement. - Collaborate with Bluestone providers and other clinical staff to educate them on the importance of accurate documentation for risk adjustment purposes. - Provide ongoing training and support to Bluestone providers to enhance their understanding of risk adjustment coding guidelines and documentation requirements. - Offer guidance and feedback to providers to facilitate improved documentation practices and ensure compliance with coding standards. - Act as a resource for clinical staff regarding coding inquiries and documentation best practices. - Maintain accurate records of chart reviews, coding opportunities identified, and outcomes of provider education efforts. - Stay current with updates and changes in risk adjustment coding guidelines and regulations. - Assist in the development and implementation of CDI initiatives to optimize coding accuracy and capture disease burden among Bluestone’s patient population. Qualifications - Bachelor's degree in Health Information Management, Nursing, or related field. - Certified Risk Adjustment Coder (CRC) certification, Risk Adjustment Coding (RAC) or related risk certification required. - Minimum of 2 years of experience in healthcare coding, with a focus on Hierarchical Condition Category (HCC) coding and risk adjustment. Requirements - Proficiency in reviewing and analyzing medical records for documentation deficiencies and coding opportunities. - Strong understanding of ICD-10-CM coding guidelines, particularly as they relate to risk adjustment. - Excellent communication skills with the ability to effectively interact with Bluestone providers and clinical staff. - Demonstrated experience in providing education and training to Bluestone professionals. - Detail-oriented with strong analytical and problem-solving skills. - Ability to work independently and manage time effectively in a remote or part-time role. - Knowledge of healthcare compliance regulations and privacy laws. - Demonstrated compatibility with Bluestone’s mission and operating philosophies. - Demonstrated ability to read, write, speak, and understand the English language. Benefits - Health Insurance - Dental Insurance - Vision Materials Insurance - Company paid Life Insurance - Company paid Short and Long-term Disability - Health Savings Account (with employer contribution) - Flexible Spending Account (FSA) - Retirement plan with 4% matching contributions - Ten (10) paid holidays for office closures - Three weeks (15 Days) Paid Time Off (PTO) - Mileage reimbursement program for field employees - Company sponsored laptop and computer accessories - Regular business hours Company Description Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period. Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida. Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 13th year in a row! Bluestone also achieved Top Workplace USA 2021-2025! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

• Lead the design and roadmapping of clinical documentation, and AI-driven technologies for healthcare enterprises. • Develop and manage speech-enabled software to reduce clinician burden. • Improve operational efficiency and patient experiences through technology-lead products and services. • Define the vision, roadmap, and features for speech technology. • Partner with engineering to build intuitive, reliable documentation and handoff experiences. • Ensure solutions function seamlessly within complex EHR environments.