[Hiring] Ambulatory Clinical Documentation Integrity Specialist @Trinity Health

Role Description

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.

Essential Functions

• Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
• Researches, collects & analyzes information.
• Identifies opportunities, develops solutions, & leads through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
• Responsible for distribution of analytical reports.
• Utilizes multiple system applications to perform analysis, create reports & develop educational materials.
• Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized.
• Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.
• Research & compiles information to support ad-hoc operational projects & initiatives.
• Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
• Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.
• Maintains a working knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines.
• Obtains appropriate clinical documentation through extensive interaction with providers and coding staff to ensure documentation reflects level of service rendered to patients is complete and accurate.
• Validates the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians & advanced practice providers.
• Conducts thorough prospective & sometimes retrospective quality reviews of ambulatory patient records, documenting all relevant findings & tracking key information through the process.
• Identifies areas where documentation requires clarification & engages with physicians, advanced practice providers & other healthcare professionals to effectively resolve discrepancies.
• Ensures medical record documentation is accurate, complete, & compliant, supporting acute or chronic conditions & medical necessity.
• Applies thorough understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment, ensuring compliance with reporting standards for claims submission.
• Identifies patterns & trends impacting documentation & coding & acts as a technical resource related to documentation, coding & billing regulations for assigned service area.

Qualifications

• Associate’s degree in Business, healthcare, Nursing or related field, or equivalent combination of education & experience.
• Experience with compliant healthcare documentation, HCC coding requirements, alternate payment models in a multi-facility, integrated health care delivery system, revenue cycle or consulting experience.
• Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Integrity (CDI), Certified Clinical Documentation Specialist – Outpatient (CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Integrity Practitioner (CDIP) credential with coding or clinical documentation integrity experience.

Requirements

• Bachelor’s degree in nursing, HIM or related healthcare field (nice to have).

Benefits

• Pay grade 13 range 75,592.7054-113,389.0581. Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.

Physical & Mental Requirements & Working Conditions

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell.
• Occasional exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.).
• Occasional exposure to or subject to noise, infectious waste, diseases & conditions.
• Frequent exposure to interruptions, shifting priorities & stressful situations.
• Continuous ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects.
• Frequent ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise.
• Occasional performance of manual dexterity activities & / or grasping / handling.
• Occasional ability to climb, kneel, crouch & / or operate foot controls.
• Frequent use of a computer / other technology.
• Continuous ability to sit with the ability to vary / adjust physical position or activity.
• Continuous maintenance of a safe working environment & use of available personal protective equipment (PPE).
• Continuous compliance with applicable Code of Conduct, policies, procedures & guidelines.
• Occasional ability to provide assistance in the event of an emergency.
• Frequent performance of activities that require standing / walking with the ability to vary / adjust physical position or activity.
• Occasional lifting of a maximum of 30 pounds unassisted.
• Occasional use of upper & lower extremities, engaging in bending / stooping / reaching & pushing / pulling.
• Continuous work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions.
• Occasional encounter of worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions.
• Occasional performance of work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients).

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.