CDI Specialist, Outpatient

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Essential Duties and Responsibilities

• Review outpatient encounters (pre visit, concurrent, and/or post visit) to assess documentation accuracy and completeness
• Identify opportunities for improved documentation related to:
  • Chronic conditions and disease specificity
  • Risk adjustment (e.g., HCCs)
  • Quality measures and medical necessity
• Provide compliant documentation clarification via query and feedback to providers through approved communication channels
• Support accurate problem list management and ongoing condition validation
• Collaborate with coding, quality, compliance, and revenue cycle teams as needed
• Track and report CDI interventions, trends, and outcomes
• Participate in provider education and training initiatives
• Stay current on outpatient coding, risk adjustment, and regulatory guidance

Compliance & Regulatory Oversight

• Ensure compliance with CMS, payer, and organizational documentation and billing requirements.
• Identify potential compliance risks, including but not limited to overcoding, undercoding, and missing and/or unsupported diagnoses.
• Apply knowledge of HCCs, risk adjustment, quality measures, and outpatient reimbursement methodologies as applicable.

Knowledge, Skills & Abilities: Qualifications
Desired Minimum Qualifications:

• An active coding credential required such as - RHIA, RHIT, CPC, COC, CCS-O, CCS, CDEO, CCDS, CDIP or CCDS-O
• 3+ years of outpatient coding, risk adjustment, outpatient CDI
• Strong understanding of:
  • ICD‑10‑CM outpatient coding
  • Risk adjustment models (e.g., Medicare Advantage HCCs)
  • Outpatient E/M documentation requirements
• Experience working in an ambulatory EHR (Epic, Cerner, or similar)

Skills & Competencies

• Strong clinical and analytical judgment
• Professional communication style
• Excellent written documentation skills
• Comfortable working independently in a fast-paced environment
• Proficient in Microsoft Office Applications

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.