Documentation Integrity and Coding Compliance Specialist

• Analyze clinical documentation for completeness, coding accuracy, coding compliance, and risk adjustment documentation integrity
• Facilitate documentation modifications and clarification to support accurate hospital, physician, professional, and value-based billing and reporting
• Work with physicians and advanced practice providers to ensure diagnoses, services, and procedures accurately reflect services provided
• Serve as an expert coding, documentation, compliance, and risk adjustment resource for coding, CDI, quality, revenue cycle, and operational teams
• Perform initial, concurrent, retrospective, and follow-up medical record reviews
• Evaluate ICD-10-CM, CPT, HCPCS, CMS-HCC capture, documentation consistency and specificity, coding accuracy, and regulatory compliance
• Document findings in audit, CDI, coding, and reporting tools and verify key documentation and coding information
• Interpret clinical information, diagnoses, medications, treatment plans, test results, payer requirements, and regulatory requirements to improve documentation
• Identify documentation improvement opportunities and collaborate with medical staff, advanced practice providers, coding, CDI, revenue cycle, and quality teams
• Communicate with providers to obtain or offer more specific documentation of diagnoses, comorbidities, complications, HCC conditions, clinical indicators, and services rendered
• Collaborate with coding staff on coding guidelines, tracking information, service profiling and reporting, data review, and physician education
• Develop and present audit findings, trends, recommendations, education, and performance information to administrative, clinical, operational, compliance, provider, and committee stakeholders
• Support clinical denials, payer audits, risk adjustment validation, regulatory reviews, denial prevention, audit defense preparation, written responses, and appeals
• Demonstrate commitment to Bronson program goals, vision, values, and mission

• Bachelor’s degree required;
  Master’s degree preferred
• Experience in clinical documentation integrity, coding compliance, risk adjustment, provider education, revenue cycle, medical record auditing, or related healthcare operations required
• Strong knowledge of ICD-10-CM, CPT, HCPCS, CMS-HCC methodology, coding guidelines, documentation requirements, reimbursement methodologies, and regulatory compliance standards required
• Required certifications: CRC – Certified Risk Adjustment Coder and CPC – Certified Professional Coder
• CDEO – Certified Documentation Expert Outpatient strongly preferred at hire and required within twelve months of employment
• CVBA – Certified Value-Based Associate recommended/preferred but not required
• RN may be required for certain departments; RN license is not required for this position
• Exceptional communication and interpersonal skills
• Self-directed and flexible
• Leadership abilities and collaboration skills
• Strong analytical skills and advanced problem-solving ability
• Knowledge of Bronson / Community systems related to assigned service line or area of responsibility
• Ability to attend to detail while maintaining awareness of overall goals, compliance priorities, and operational impact
• Ability to function effectively in a fluid, dynamic, rapidly changing environment
• Prefer experience with risk adjustment strategy, RAF optimization, CMS-HCC documentation, audit defense preparation, coding quality audits, and value-based care models

Demonstrates expertise in clinical documentation integrity, coding compliance, and risk adjustment, with a strong focus on ICD-10-CM, CPT, and HCPCS methodologies. Capable of collaborating with healthcare providers and teams to enhance documentation accuracy and support revenue cycle operations.

• ICD-10-CM Coding
• CPT Coding
• HCPCS Coding
• Certified Risk Adjustment Coder (CRC)
• Certified Professional Coder (CPC)

• Clinical Documentation Integrity
• Coding Compliance
• Risk Adjustment
• Medical Record Auditing
• Documentation Requirements
• Reimbursement Methodologies
• Regulatory Compliance Standards
• Audit Defense Preparation
• Data Review
• Provider Education

• Exceptional Communication Skills
• Interpersonal Skills
• Leadership Abilities
• Collaboration Skills
• Analytical Skills

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Coder (CPC)
• Certified Documentation Expert Outpatient (CDEO)
• Certified Value-Based Associate (CVBA)

• Revenue Cycle
• Value-Based Care Models
• CMS-HCC Methodology
• Audit Defense
• Risk Adjustment Strategy

• CDI Tools
• Coding Tools
• Reporting Tools