Mass General Brigham connects a full spectrum of care across a system of academic medical centers, specialty and community hospitals, physician networks, a heal
Inpatient Clinical Documentation Integrity Risk Adjustment Specialist
Location
United States
Posted
12 days ago
Salary
$79.6K - $115.7K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Inpatient Clinical Documentation Integrity Risk Adjustment Specialist
Mass General Brigham
Role Description The Inpatient CDI Risk Adjustment Specialist reports to the Senior Manager, CDI Risk Adjustment and conducts advanced second level clinical documentation reviews for inpatient encounters focusing specifically on documentation opportunities supporting risk-adjusted methodologies to accurately reflect the quality of care being delivered across MGB. This role focuses on improving quality outcomes through improvement of risk-adjusted reporting impacting the O/E for multiple MGB enterprise quality initiatives while adhering to CDI established policies, procedures, and professional guidelines. - Perform Inpatient Risk Adjustment CDI reviews to identify discrepancies or missed opportunities in clinical documentation that impact quality outcomes through risk-adjusted measures, specifically Vizient and Elixhauser variables. - Accurately interpret clinical information in the Inpatient health record and evaluate clinical indicators to identify potential diagnoses and query opportunities impacting quality outcomes. - Issue clinically credible and compliant queries to providers as appropriate with focus on addressing organizational quality initiatives. - Escalate complex cases to the CDI leadership team or physician advisors, as needed. - Track and report clinical documentation or CDI issues affecting quality measures. - Maintain up-to-date knowledge of CDI practices, inpatient coding guidelines, CMS/OIG regulatory changes, and AHA Coding Clinic. - Work collaboratively with vendor-supported primary CDI Specialist workforce to ensure accurate clinical documentation and appropriate principal diagnosis assignment for all reviewed encounters. - Meet or exceed MGB CDI Risk Adjustment Specialist key performance indicators. - Use the Mass General Brigham values to govern decisions, actions and behaviors. - Other duties as assigned. Qualifications - Registered Nurse (RN), Advanced Practice Clinician (NP/PA), or other clinically licensed professional. - 5 years of acute medical/surgical care experience required. - 3-5 years of advanced inpatient clinical documentation improvement experience required. - Certification in Clinical Documentation preferred. Requirements - In-depth knowledge of clinical disease processes and inpatient care delivery. - Demonstrated proficiency in risk-adjustment CDI knowledge, specifically Vizient and Elixhauser methodologies. - Advanced understanding of risk adjustment methodologies impacted by inpatient clinical documentation. - Can explain observed-to-expected ratios and their calculation. - Advanced understanding of MS-DRG/APR-DRG logic, SOI/ROM methodology, and CC/MCC assignment. - Strong analytical, critical thinking, and clinical reasoning skills. - High attention to detail and commitment to accuracy and compliance. - Excellent written and verbal communication skills. - Proficiency in CDI software systems to document, track, report outcomes and interact with coding professionals. - Knowledgeable about current CDI industry trends. - Proactive in researching and resolving clinical and CDI questions. - Self-driven, able to prioritize tasks, and adapt quickly to change. - Dedicated to continuous learning and professional growth. - Team-oriented with strong collaboration skills. Benefits At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.
Related Guides
Related Categories
Related Job Pages
More Risk Jobs
Title: Processor (REMOTE) Location: Grand Rapids, MI Job Description: Job Description: Processor Fully Remote Member First Mortgage is seeking a Processor to join our growing Processing team. This is an excellent opportunity to join our award-winning team which has been recognized as Best and Brightest companies to work for in the nation! In this role you will be responsible for providing clerical support for all mortgage loan processing activities. Obtains and verifies necessary information and prepares documents for underwriting and closing review. Founded on the credit union philosophy of 'People Helping People', we have become the trusted full-service mortgage provider to over 200 credit unions across the U.S. This philosophy, along with our core values of honesty and integrity, make careers with Member First Mortgage dynamic and rewarding through our friendly and family-oriented culture that is dedicated to the growth and success of our employees. Benefits We Offer: - Generous and competitive healthcare packages - Employer paid short-term and long-term disability - Employer paid Life Insurance - 100% Employer paid Vision - 401K Plan with match - 20 days PTO - no waiting periods! - Fun, laid back, and collaborative team environment. Responsibilities: - Reviews new residential loan application files to verify that application data is complete and meets Company standards, including type and amount of mortgage, borrower assets, liabilities, and length of employment. Clarifies missing or questionable information and tracks development of information to ensure compliance with underwriting guidelines. Clears prior to funding conditions. - Communicates status of loans to buyer, seller, realtor, credit union and title company. Resolves or refers requests and problems promptly and courteously. - Calls or writes credit bureau and employer to verify accuracy of information. - Orders and follows up on essential third-party items from vendors (i.e., appraisal, title, flood certificate, written verification of income/employment, payoffs, etc.). - Records data on status of loans, including number of new applications and loans approved, canceled, or denied. Prepares monthly status report. Experience: 10 years' experience in mortgage loan processing Education: (1) A bachelor's degree, or (2) achievement of formal certifications recognized in the industry as equivalent to a bachelor's degree (e.g. information technology certifications in lieu of a degree). Other Skills: - Understanding of the mortgage loan processing functions, including FHA/VA and conventional lending. - Knowledge of mortgage related requirements, procedures, and underwriting criteria. - Ten key calculator, typewriter and keyboard skills. - Good basic math skills. - Well organized. Physical Requirements: While performing the duties of this job, the employee is regularly required to sit, stand, and walk. The employee must occasionally lift and/or move up to 10 pounds. The employee is frequently required to spend extended hours in front of a computer screen, use hands and fingers, and to speak in and listen carefully on the telephone. Work Environment: Schedule: Monday through Friday, 8:30am – 5pm EST. While performing the duties of this job, the employee regularly works in a remote and/or in office setting. If you are looking for a company that is dedicated to your success and is ethically motivated to provide exceptional member service, we encourage you to apply!
Alabang (96050), Philippines, Muntinlupa City, National Capital Region (Manila) Sr. Risk Manager, Control Testing Summary: - This Senior Manager is responsible for the development and execution of the controls testing methodology in alignment with the Enterprise Control Standard and our internal framework, ensuring unassailable and appropriate evaluation of effectiveness of control activities. This role will collaborate with leaders to deliver results that have a direct impact on the company's bottom line. General Responsibilities: - Serving as a people leader for a team of associates and non-associates - Designing, developing, and continuously evolving the controls testing methodology, while also autonomously driving the program to evaluate effectiveness of controls in adherence with the methodology - Partnering cross-functionally with program customers and program assessors to effectively drive and evolve delivery - Providing strategic direction to project teams, peers, and stakeholders to drive results, solve problems, and influence outcomes - Building relationships and collaborating with key stakeholders - Drive sustainability, amplify simplification & automation, enable ownership & accountability through transparency, and strengthen the control ecosystem - All other job-related duties that may be assigned from time to time Basic Qualifications: - Bachelor's Degree in Business Management, with knowledge on Business Law and Auditing controls - At least 3 years of experience in control testing or Internal Audit - Amenable to working a midshift schedule in a hybrid setup Capabilities: - Strong strategic mindset with significant risk management and testing expertise - Ability to lead teams both directly and indirectly to deliver high-quality value - Exhibit great judgment in solving challenging problems - Subject matter expertise to provide independent evaluation of the health of our control ecosystem - Change resiliency to maintain momentum in a dynamic, fast-paced and complex environment and among competing priorities - Strong partnership and communication skills to engage and influence critical stakeholders Preferred Qualifications: - Master's or MBA Degree - 3+ years of Corporate Management Consulting experience - 3+ years of Financial Services industry experience - 3+ years of regulatory compliance or credit experience - 3+ years of People Management experience - 5+ years of Risk Management experience - 5+ years of controls testing experience - 5+ years of Project Management experience - Project Management certification - Lean, Agile or Six Sigma certification No agencies please. Capital One is an equal opportunity employer (EOE, including disability/vet) committed to non-discrimination in compliance with applicable federal, state, and local laws. Capital One promotes a drug-free workplace. Capital One will consider for employment qualified applicants with a criminal history in a manner consistent with the requirements of applicable laws regarding criminal background inquiries, including, to the extent applicable, Article 23-A of the New York Correction Law; San Francisco, California Police Code Article 49, Sections 4901-4920; New York City's Fair Chance Act; Philadelphia's Fair Criminal Records Screening Act; and other applicable federal, state, and local laws and regulations regarding criminal background inquiries. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation, please contact Capital One Recruiting at 1-800-304-9102 or via email at RecruitingAccommodation@capitalone.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodations. For technical support or questions about Capital One's recruiting process, please send an email to Careers@capitalone.com Capital One does not provide, endorse nor guarantee and is not liable for third-party products, services, educational tools or other information available through this site. Capital One Financial is made up of several different entities. Please note that any position posted in Canada is for Capital One Canada, any position posted in the United Kingdom is for Capital One Europe and any position posted in the Philippines is for Capital One Philippines Service Corp. (COPSSC).
• Own and evolve the IT Governance framework for digital platforms focusing on control standards, and operational enforcement • Design and implement technical governance controls embedded in SDLC and platform delivery workflows • Actively monitor governance effectiveness using leading indicators and control health metrics, providing valuable insights for continuous improvement • Design and maintain proactive KPI dashboards that provide visibility into: Technology governance adherence, Access, auditability, and traceability controls, Third-party and vendor digital risk posture • Partner with Data & Analytics teams to operationalize governance through: Data catalogs, Stewardship models, Data quality monitoring • Serve as escalation point for data integrity risks impacting clinical, operational, or regulatory outcomes • Establish and operationalize an AI Governance framework aligned with enterprise responsible AI framework • Govern both vendor provided and internally developed AI capabilities • Support IT inspection readiness, including: Evidence preparation and traceability, Governance documentation and KPI dashboards, Coordinated IT responses during regulatory and sponsor inspections • Build on SOPs Ability to operate SOPs as inspection-defensible controls through ownership, SOP-to-control traceability, change impact governance, and effectiveness monitoring
• Manage the enterprise data governance operating model, including governance councils, domain working sessions, decision logs, and follow-through actions. • Define and maintain enterprise governance standards, policies, and procedures that support scalable and trusted analytics delivery. • Establish governance operating cadences and cross-functional collaboration processes across business and technical teams. • Provide leadership, coordination, and operational direction for Reporting & Analytics Business Systems Analysts (BSAs), QA resources, and other data-focused analysts supporting enterprise reporting and governance initiatives. • Establish standardized intake, requirement, testing, documentation, and governance processes across analytics delivery teams. • Improve cross-functional collaboration and delivery quality by aligning governance requirements with business analysis, QA validation, and reporting development practices. • Support resource prioritization, workload management, and continuous improvement across the Reporting & Analytics support functions. • Define and manage enterprise data ownership and stewardship structures, including clear roles, responsibilities, and decision rights across key business domains. • Partner with business leaders and technical teams to ensure accountability for enterprise data quality, consistency, and lifecycle management. • Facilitate governance discussions, issue resolution, prioritization, and policy adoption across stakeholders. • Own and maintain the enterprise business glossary and measure governance process, including: • Standard business definitions • Approval workflows • Change management and version control • Documentation standards • Improve consistency of enterprise reporting by reducing duplicate metrics and conflicting KPI definitions. • Define governance standards for metadata management, lineage visibility, access conventions, retention policies, and certification of trusted datasets. • Partner with analytics and engineering teams to improve transparency and traceability of enterprise data assets. • Support scalable governance practices within cloud-based analytics and lakehouse environments. • Embed governance requirements into delivery and agile processes so governance becomes part of standard execution rather than an after-the-fact activity. • Coordinate with data quality and business stakeholders to align governance standards with monitoring, issue management, and remediation ownership. • Support consistent and governed reporting practices across Power BI, Excel, and enterprise analytics platforms.



