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Boston Medical Center

Based in Boston, Massachusetts, Boston Medical Center (BMC) is the Boston University School of Medicine's primary teaching affiliate and a private, not-for-prof

Outpatient Clinical Documentation Specialist

Location

United States

Posted

59 days ago

Salary

0

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Outpatient Clinical Documentation Specialist

Boston Medical Center

• Provide clinically based prospective, concurrent, and retrospective reviews of medical records for WellSense of members enrolled in value-based agreements • Review risk adjustment gap lists for members, including suspect conditions • Perform chart reviews to determine clinical validity of open gaps • Utilize Physician documentation queries to communicate clinical indicators to Physicians/Other Qualified Health Care Providers • Facilitate appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality • Track and Trend CDI findings and provider engagement for clinical documentation education purposes for any specialty within the hospital system

Job Requirements

  • Bachelor’s degree in Nursing or Health Information Management is required
  • Minimum 5 years related experience working on the payer or provider side in Risk Adjustment Validation including prospective documentation reviews and pre-visit planning
  • Certified Risk Adjustment Coder required
  • Population Health experience, NCQA/HEDIS CDS experience preferred
  • Knowledge of care delivery documentation systems and related medical record documents
  • Excellent understanding of ICD10CM coding and guidelines
  • Ability to work independently in a time-oriented environment
  • Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes

Benefits

  • Health insurance
  • Discretionary annual bonuses
  • Merit increases
  • Flexible Spending Accounts
  • 403(b) savings matches
  • Paid time off
  • Career advancement opportunities
  • Resources to support employee and family well-being

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