Clinical Risk Adjustment Documentation Specialist
Remote
Job Summary
Conduct prospective reviews of medical records from physician practices and outpatient settings to validate chronic conditions, ensure documentation accuracy, and support accurate HCC capture using Epic and OurPractice Advisories. Manage work queues, review inventories, and track OPA-related activities to meet productivity targets and complete CDI interventions. Monitor, analyze, and report CDI outcomes, documentation trends, and HCC recapture performance to identify improvement opportunities and support program goals. Requires active LPN or RN license, minimum two years of ambulatory Clinical Documentation Integrity experience, and proficiency in Epic workflows.
Required Qualifications
- Minimum 2 years of ambulatory Clinical Documentation Integrity, Risk Adjustment, or related healthcare documentation experience
- Active LPN or RN license
Desired Qualifications
- CCDS, CCDS-O, CDIP, CDEO and/or CRC certification
- Proficiency in Epic workflows, including interpretation and management of OurPractice Advisories (OPAs)
- Strong understanding of: ICD-10-CM coding guidelines, HCC documentation and coding requirements
- Strong understanding of clinical criteria for HCC diagnoses
- Excellent communication, critical thinking, and organizational skills
- Comfortable using MS Office, email, VPNs, virtual machines, two-factor authentication, and video conferencing tools (MS Teams, Zoom, etc.)
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