Outpatient Clinical Documentation Integrity Specialist

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Full Time Professional Oceanport, NJ, US

17 days ago Requisition

Join Bold Age 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:

• 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? Bold Age 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 Specialist

The Outpatient Clinical Documentation Integrity (CDI) Specialist improves the accuracy, completeness, and compliance of clinical documentation and coding across the organization’s multi-facility PACE healthcare system. This role conducts prospective, concurrent, and retrospective chart reviews to support HCC capture, RAF accuracy, ICD-10-CM coding, quality outcomes, and regulatory compliance. The CDI Specialist partners with providers, coding professionals, finance, revenue cycle, and interdisciplinary teams to ensure diagnoses are clinically supported and appropriately documented while providing compliant education, queries, and feedback that strengthen documentation quality and accurately reflect participant acuity and complexity.

• Performs prospective, concurrent, and retrospective chart reviews across outpatient, home, inpatient, skilled nursing, and post-acute settings to identify documentation gaps and improvement opportunities.
• Supports compliant HCC capture and RAF accuracy for Medicare Advantage, Medicaid, and PACE populations using current CMS risk-adjustment models and guidelines.
• Identifies opportunities to improve diagnosis specificity, chronic condition documentation, annual HCC recapture, and accurate reporting of participant acuity and complexity.
• Ensures diagnoses are clinically supported, meet CMS documentation requirements and MEAT criteria, and include appropriate clinical linkages when documented by the provider.
• Conducts pre-visit reviews to identify suspected conditions, recapture opportunities, and documentation needs for provider consideration.
• Develops compliant provider queries when documentation requires clarification or additional specificity.
• Collaborates with coding professionals to ensure documentation supports accurate ICD-10-CM coding, HCC assignment, procedures, modifiers, place of service, and other encounter elements.
• Educates providers on documentation specificity, chronic condition capture, risk adjustment, and CMS requirements through collaborative and non-punitive feedback.
• Partners with clinical, coding, quality, compliance, finance, revenue cycle, and operational teams to improve documentation integrity, coding accuracy, and care planning.
• Participates in documentation audits and quality assurance activities and supports preparation for CMS RADV, payer, and regulatory audits.
• Monitors documentation and coding trends, reports findings, and recommends workflow and process improvements.
• Evaluates EHR workflows, documentation templates, and reporting tools to improve documentation accuracy and efficiency.
• Maintains compliance with CMS regulations, ICD-10-CM Official Guidelines, organizational policies, and ethical documentation standards.
• Maintains current knowledge of CDI, risk-adjustment methodologies, coding updates, and documentation best practices through ongoing professional development.

• Improvement in HCC capture and annual HCC recapture rates.
• Increased documentation meeting MEAT criteria.
• Improved RAF accuracy.
• Reduction in vague, unspecified, or unsupported diagnoses.
• Improved ICD-10-CM documentation specificity.
• Positive internal and external audit performance.
• Improved provider documentation following educational interventions.
• Accurate and timely completion of chart reviews and provider queries.

• Active, unrestricted RN, PA, NP, MD/DO, or other clinically licensed healthcare professional license preferred (or equivalent clinical documentation experience as approved by the organization).
• CCDS, CDIP, CCS, CPC, CRC, or other CDI/coding certification preferred.
• Minimum of three (3) years of clinical documentation improvement, outpatient CDI, risk adjustment, HCC coding, or related healthcare documentation experience.
• Experience with Medicare Advantage, Medicaid, and/or PACE…