Outpatient Clinical Documentation Integrity Specialist

Position Summary The Outpatient Clinical Documentation Integrity Specialist is responsible for preforming concurrent and retrospective reviews of outpatient clinical documentation to ensure accurate reflection of the patient's severity of illness, the complexity of care provided, and the medical necessity of services. This role serves as a vital bridge between clinical care and the revenue cycle, ensuring that the medical record is a precise clinical story that supports compliant coding and optimizes reimbursement. Education Associate's degree in Health Information Administration or similiar Healthcare related degree

• Preferred Experience 3-5 Years outpatient coding
• Required Proficiency in using and creating of data using Excel spreadsheets, preparing and presenting materials, reports or data using PowerPoint, Excel and other similar tools; attention to detail
• Required Working knowledge of Centers of Medicare and Medicaid (CMS) billing regulations
• Required License & Certification Certification by American Health Information Management Association (AHIMA)

CCA, RHIT, RHIA, CCS

; or certification by the American Academy of Professional Coders (AAPC) CPC or COC or comparable medical coding certification

• Required ACDIS Certified Clinical Documentation Specialist
• Outpatient (CCDS-O)
• Preferred Core Job Functions Conducts daily reviews of outpatient patient encounters to help identify potential gaps in documentation for missing diagnoses, conflicting clinical indicators, or lack of specificity.

Evaluate documentation to ensure it supports the billed level of service and meets payer requirements of medical necessity. Creates and presents education using adult learning methods to clinical staff and Revenue Cycle staff regarding complex documentation, coding, and reimbursement on outpatient coded data. Serves as an expert coding and documentation resource, acting as a liaison among clinical and non-clinical departments. Actively monitors and interprets monthly updates to National Coverage Determinations (LCDs) and Local Coverage Determinations (LCDs) to ensure clinical documentation meets medical necessity criteria. Reviews annual updates to Outpatient Prospective Payment System (OPPS) Final Rule to identify needed shifts in clinical documentation requirements for complex procedures. Translates complex regulatory language and payer specific policy changes into actionable "Clinical Documentation Alerts" for Providers and clinical staff. Works with Revenue Integrity Supervisors to identify denial trends. Helps to identify revenue "leaks" in Revenue Cycle that can be resolved with better documentation at the point of care.