Clinical Documentation Integrity Specialist RN

About the role

Reliant Medical Group, part of the Optum family, is hiring a Clinical Documentation Integrity Specialist RN. The position is remote and open only to Massachusetts residents, full time (40 hours per week), within the Population Health - Risk adjustment department. The nurse reviews electronic medical records to ensure accurate clinician documentation and supports risk adjustment programs.

Key responsibilities

• Review encounters in the electronic medical record to check the accuracy and appropriateness of clinician documentation against risk adjustment program standards
• Use abstract reports to substantiate HCC diagnoses that have been billed or are relevant but do not appear on the patient's problem list
• Provide concurrent and retrospective abstraction for all Reliant Risk Adjustment programs
• Independently conduct chart reviews, assign accurate diagnosis codes to the Problem List and review new patients for potential diagnoses
• Train clinicians on risk adjustment programs with the coding education team, with possible ad hoc site visits
• Help develop, implement and monitor procedures supporting risk adjustment capture
• Apply knowledge of CMS/Medicare coding regulations and ICD-10 and CPT systems

Required profile

• Graduate of a state-approved nursing school with an unrestricted Massachusetts nursing license
• Certified professional coder (CPC, CCS-P, CCS, CPC-H, CRC-risk, AAPC) or ability to obtain certification while working
• American Heart Association Basic Life Support (BLS)
• 3+ years of nursing experience, including 3 years with chronic disease patients in ambulatory or inpatient settings
• Preferred: BSN, ACLS, 2+ years across multiple specialties, computer and EMR experience, strong written communication and critical thinking skills

Required skills

• ICD-10 and CPT coding knowledge
• Word processing and spreadsheet software
• Electronic medical record experience or aptitude to learn it

What we offer

• Pay of $29-$52 per hour depending on factors such as education, experience and certifications
• Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (subject to eligibility)
• Remote work flexibility for Massachusetts residents, subject to the company's telecommuter policy