[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.
• Validates the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population.
• Conducts thorough prospective & sometimes retrospective quality reviews of ambulatory patient records.
• Identifies areas where documentation requires clarification & engages with healthcare professionals to resolve discrepancies.
• Ensures medical record documentation is accurate, complete, & compliant.
• Applies understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment.
• Identifies patterns & trends impacting documentation & coding.

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.

Additional Qualifications

• Bachelor’s degree in nursing, HIM or related healthcare field.

Requirements

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell.
• Occasional exposure to fumes, odors, dusts, mists & gases, biohazards / hazards.
• Frequent exposure to interruptions, shifting priorities & stressful situations.
• 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.
• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications.
• Perform manual dexterity activities & / or grasping / handling.
• Ability to climb, kneel, crouch & / or operate foot controls.
• Use a computer / other technology.
• Maintain a safe working environment & use available personal protective equipment (PPE).
• Ability to provide assistance in the event of an emergency.

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.

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.