CDI Pro Fee Specialist: HCC/E&M Optimization

University Hospitals; Cleveland (OH); On-site; USD 70,000 - 110,000; Full time

Job summary

University Hospitals in Cleveland seeks a Professional Fee Clinical Documentation Specialist to improve documentation accuracy, support patient complexity and appropriate E/M levels. You will identify HCC opportunities and coordinate with CDI teams to educate providers on proper coding and billing practices.

The role emphasizes pre-visit and post-claim reviews, ongoing education, and adherence to CMS and HIPAA guidelines within the hospital and clinic setting.

Qualifications

• Pre-visit reviews identify documentation opportunities for HCCs and risk adjustment.
• Post-claim reviews focus on E/M level assignments and HCCs.
• Communicate documentation, coding and billing practices to providers per guidelines.
• Maintain confidentiality of PHI per HIPAA and organizational policies.

Responsibilities

• Coordinate with Professional Fee CDI Program leadership and colleagues to foster teamwork.
• Perform pre-visit chart reviews to identify documentation opportunities and new HCC diagnoses.
• Perform post-claim reviews to ensure appropriate E/M levels and HCC capture.
• Create specialty-specific education from data analytics and clinical reviews.
• Develop and maintain an education schedule for providers across hospital and clinics.
• Provide ongoing feedback on documentation quality during meetings or individually.
• Stay current on CMS guidelines and HCC implications for documentation.
• Protect patient PHI and adhere to UH policies.

Job description

University Hospitals in Cleveland seeks a Professional Fee Clinical Documentation Specialist to improve documentation accuracy, support patient complexity and appropriate E/M levels. You will identify HCC opportunities and coordinate with CDI teams to educate providers on proper coding and billing practices.

The role emphasizes pre-visit and post-claim reviews, ongoing education, and adherence to CMS and HIPAA guidelines within the hospital and clinic setting.