Outpatient Clinical Documentation Integrity Manager

Join BoldAge PACE and Make a Difference! Why work with us?

A People First Environment:

We make what is important to those we serve important to us. Make an

Impact:

Enhance the quality of life for seniors.

Professional Growth :

Access to training and career development.

Competitive Compensation:

Medical/Dental Generous Paid Time Off 401K with Match• Life Insurance Tuition Reimbursement Flexible Spending Account Employee Assistance Program

BE PART OF OUR MISSION!

Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants.

Our approach is simple:

We listen to our participants and their caregivers to truly understand their needs and desires. Outpatient Clinical Documentation Integrity Manager Remote

JOB SUMMARY

The Outpatient Clinical Documentation Integrity Manager (CDI) is responsible for managing, coordinating and performing day-to-day operations for the outpatient clinical documentation improvement program across the multi-facility PACE healthcare delivery system. Day-today operations include personnel management, education, training, productivity, work assignments, quality reviews and report management for the Outpatient CDI program. The Clinical Documentation Integrity Manager improves the accuracy, completeness, and specificity of clinical documentation and coding to support Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF) accuracy for Medicare and Medicaid populations across a national PACE healthcare organization. This role leads a team of Clinical Documentation Integrity Specialists (CDIS) and partners with the Primary Care Providers under the direction of the Chief Clinical Officer to ensure diagnoses are clinically supported, properly documented and coded in alignment with CMS guidelines. The CDI Manager oversees the CDIS staff and participates in retrospective and prospective chart reviews, develops pre-visit coding guides, interfaces with the finance and revenue cycle team to ensure codes are not missed. This role will include real-time education, queries and feedback directly to providers, care teams and other stakeholders to ensure that clinical documentation accurately, completely, and compliantly reflects participant acuity, chronic conditions, and clinical complexity to support CMS risk adjustment, ICD10-CM documentation, quality outcomes, regulatory compliance, and person‑centered care planning.

ESSESNTIAL DUTIES AND RESPONSIBILITIES

: Clinical Documentation Integrity & Risk Adjustment Leadership Leads the organization's CDI and risk adjustment strategy for Medicare Advantage, Medicaid, and PACE full‑risk populations. Serves as the clinical subject matter expert for Hierarchical Condition Categories (HCCs), RAF scoring of V24 and V28 CMS documentation standards. Conducts queries and reviews clinical documentation across settings (center‑based, home, inpatient, post‑acute) to identify documentation gaps, risks, and opportunities. Ensures diagnoses are clearly monitored, evaluated, assessed, and treated (MEAT) within the medical record, confirms linkage between conditions when auditing and complications are explicitly linked to carry full weight of RAF score. Documentation Review & Query Oversight Establishes standards and workflows for retrospective chart audits to ensure compliant documentation and provider query processes. Establishes standard operating procedures related to the audit process including prospective (pre-visit) chart scrubs to highlight suspected chronic conditions, previously captured HCCs requiring annual recapture, documentation gaps needing clarification. Performs targeted and high‑risk chart reviews to validate diagnosis accuracy and chronic condition management. Oversees the development and escalation of documentation queries in collaboration with coding staff. Ensures documentation improvement efforts remain clinically appropriate, compliant, and audit‑defensible. Ensures appropriate coding for all elements of clinical encounter documentation and other PACE related encounter documentation - example:

ICD-10/HCC

selection, Procedure and sub-procedure codes, procedure modifiers, Place of Service, etc. Provider Education & Clinical Engagement In coordination with the Chief Clinical Officer develops and delivers structured education for PCP staff focused on documentation accuracy, specificity, and annual condition recapture. Provides real‑time, retrospective, and trend‑based feedback to providers in a collaborative, non‑punitive manner. Partners with Regional Medical Directors and clinical leadership to reinforce accountability and documentation best practices. Serves as a trusted clinical advisor to providers, supporting improved documentation without disrupting care delivery. Team Leadership & Program Development Builds, mentors, and leads a CDI and risk adjustment team (4-6 staff), including certified coders and clinical documentation integrity specialists. Establishes role clarity, workflows, productivity expectations, and quality benchmarks for team members. Provides clinical oversight and coaching to ensure alignment between documentation, coding, and risk adjustment goals. Supports hiring, onboarding, competency validation, and performance management in partnership with leadership and HR. Compliance, Audits & Quality Assurance Leads internal monitoring, auditing, and quality assurance activities related to documentation and risk adjustment. Prepares for and supports external audits including CMS RADV, payer, and state reviews. Identifies compliance risks, develops corrective action plans, and monitors resolution. Ensures CDI and risk adjustment practices align with CMS regulations, organizational policies, and ethical standards. Collaboration, Reporting & IDT Integration Collaborates with coding, quality, compliance, finance, and operational leaders to align documentation integrity with organizational performance goals. Engages with the Interdisciplinary Team to ensure documentation reflects the full clinical and functional complexity of participants. Develops and presents risk adjustment and documentation performance reports to leadership. Supports integration of risk adjustment principles into care planning, reassessment, and ongoing participant management. Continuous Improvement & Program Growth Designs scalable CDI and risk adjustment workflows to support organizational growth and maturity. Evaluates EHR tools, templates, and reporting capabilities to improve efficiency and accuracy. Maintains current knowledge of CMS guidance, ICD‑10‑CM updates, and evolving risk adjustment models. Recommends policy, workflow, and technology enhancements to strengthen documentation integrity. Metrics for Success Improvement in HCC capture and recapture rates, including chronic condition accuracy and annual recapture compliance. Increased percentage of diagnoses meeting MEAT criteria and having full RAF capture with complications, specificity and clinical relationship between conditions when present. Reduction in unsupported, vague, or non‑specific diagnoses. Positive performance trends in internal and external audits. Improved provider documentation accuracy following education interventions. Successful recruitment, onboarding, and retention of CDI and risk adjustment staff.

EXPERIENCE AND EDUCATION

Active, unrestricted Registered Nurse (RN) license required.

CCDS, CDIP, CCS

professional certification Minimum of five (5) years of clinical nursing experience, with at least three (3) years in clinical documentation improvement, risk adjustment, or HCC‑focused roles. Demonstrated expertise in Medicare Advantage, Medicaid, and/or PACE full‑risk models. Strong working knowledge of ICD‑10‑CM coding guidelines and CMS risk adjustment methodologies. Experience educating and collaborating with provider‑level staff (MD/DO, NP, PA). Prior experience leading or mentoring CDI or coding teams strongly preferred. Proficiency with EHR systems, data analysis, and clinical reporting tools.

PRE-EMPLOYMENT REQUIREMENTS

Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance. Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact. Employment with BoldAge PACE is contingent upon successful completion of post-offer pre-employment screening and verification processes BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Match begins after one year of employment Remote, Full Time, Days Full Time