Ambulatory CDI & Risk Adjustment Specialist

Lexington Health; Columbia (SC); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Day One Benefits

401(k) Match

Life Insurance

Disability Insurance

Tuition Reimbursement

Student Loan Forgiveness

FSAs

Job summary

Lexington Health is seeking an ambitious Ambulatory Clinical Documentation Integrity (CDI) Specialist to conduct comprehensive reviews of ambulatory records, identify HCC opportunities, and drive RAF score accuracy. The role emphasizes collaboration with physicians, nurses, and coders to improve documentation and patient outcomes.

The position requires an Associate's Degree in Nursing, 3+ years of clinical nursing experience, and active RN licensure with certification options (CDEO, CRC, CCDS-O,

Qualifications

• Associate's Degree in Nursing required.
• Minimum of 3 years clinical nursing experience; CDI, coding, or risk adjustment experience preferred.
• Current Registered Nurse license; professional certifications in outpatient CDI coding required within 2 years if not possessed at start.

Responsibilities

• Validate working HCC diagnoses affecting RAF scores by collaborating with physicians and advanced practice providers.
• Conduct prospective reviews of ambulatory records, documenting findings and tracking information.
• Identify documentation clarifications and engage providers to resolve discrepancies.
• Maintain strict patient confidentiality and comply with privacy regulations.
• Ensure documentation supports medical necessity and describes severity of illness for risk adjustment.
• Develop relationships with care teams to promote CDI program success.

Education

Associate's Degree in Nursing

Job description

Lexington Health is seeking an ambitious Ambulatory Clinical Documentation Integrity (CDI) Specialist to conduct comprehensive reviews of ambulatory records, identify HCC opportunities, and drive RAF score accuracy. The role emphasizes collaboration with physicians, nurses, and coders to improve documentation and patient outcomes.

The position requires an Associate's Degree in Nursing, 3+ years of clinical nursing experience, and active RN licensure with certification options (CDEO, CRC, CCDS-O,