Clinical Documentation Improvement Specialist

Health Choice Network; Oregon; Hybrid; USD 80,000 - 120,000; Full time

Benefits offered by this job

Remote work

Employer-paid health insurance

PTO

403(b) retirement plan with employer贡献

Professional development

Mission-driven culture

Job summary

Health Choice Network is seeking a Clinical Documentation Improvement (CDI) Specialist to enhance documentation accuracy across our nationwide organization. You will serve as SME on ICD-10-CM, HCC coding, risk adjustment, and provider education; conduct chart reviews, identify gaps, and partner with plans to improve value-based care.

This role supports remote work from anywhere in the United States; requires 3+ years in Medicare/Medicaid risk adjustment and AHIMA/AAPC credentials.

Qualifications

• Associate degree required; bachelor's preferred.
• CRC or CDI/CCS certification required.
• Minimum 3 years Medicare/Medicaid Risk Adjustment experience.
• Strong ICD-10 coding and clinical documentation review history.
• Knowledge of anatomy, physiology and disease processes.
• Proficiency in HCC coding and risk adjustment programs.
• Excellent written and verbal communication skills.
• Ability to work independently in a remote environment.

Responsibilities

• Lead CDI and risk adjustment activities across the organization.
• Review medical records for documentation quality and coding accuracy.
• Educate providers and care teams on documentation best practices.
• Collaborate with health plans on risk adjustment and value-based care initiatives.
• Participate in clinical quality, revenue cycle, and data analytics projects.
• Monitor changes in regulations and reimbursement impacts.

Skills

Medicare/Medicaid Risk Adjustment

HCC coding

Clinical Documentation Improvement

Provider education

ICD-10 coding

Remote work capability

Education

Certified Risk Coder (CRC)

CDI/CCS certification (AHIMA)

Associate degree

Bachelor's degree preferred

Tools

Epic EMR

Job description

Position Summary

Are you passionate about clinical documentation, risk adjustment, and improving the quality of patient care? We're looking for an experienced Clinical Documentation Improvement (CDI) Specialist to join our team and play a critical role in ensuring the accuracy, completeness, and quality of clinical documentation across our organization.

If you're a collaborative problem solver with a strong background in Medicare and Medicaid Risk Adjustment, HCC Coding, Clinical Documentation Improvement, and provider education, we'd love to hear from you.

What You'll Do

Clinical Documentation Improvement & Risk Adjustment

• Serve as a subject matter expert on ICD-10-CM Coding Guidelines, AHA Coding Clinic guidance, and Risk Adjustment methodologies.
• Conduct proactive medical record reviews to evaluate documentation quality, diagnosis coding accuracy, co-morbidities, complications, and appropriate secondary diagnoses.
• Ensure patient conditions are accurately documented and coded to support quality care and appropriate risk stratification.
• Identify documentation and coding trends impacting patient risk scores and value-based care performance.

Provider Education & Training

• Develop and deliver engaging education programs for providers, coders, and clinical care teams.
• Provide ongoing guidance on documentation best practices, coding updates, compliance requirements, and risk adjustment principles.
• Create educational tools, resources, and training materials that improve coding accuracy and documentation quality.
• Partner with providers to identify opportunities for documentation improvement and workflow optimization.

Value-Based Care & Strategic Initiatives

• Collaborate with contracted health plans on risk adjustment and value-based care initiatives.
• Support auditing activities, review health plan findings, and develop performance improvement plans when needed.
• Participate in clinical quality, revenue cycle, population health, and data analytics initiatives.
• Monitor regulatory, coding, and reimbursement changes and communicate impacts across the organization.

Data Analysis & Collaboration

• Analyze documentation and coding trends to identify opportunities for improvement.
• Work closely with clinical leadership, coding teams, health plans, and operational stakeholders.
• Help drive strategies that improve quality scores, risk adjustment accuracy, and overall organizational performance.

What You'll Bring

Required Qualifications

• Associate degree required; Bachelor's degree preferred.
• Certified Risk Coder (CRC) through AAPC or CDI/CCS certification through AHIMA.
• Minimum of 3 years of experience in Medicare and/or Medicaid Risk Adjustment, including HHS-HCC, CMS-HCC, or DxCG methodologies.
• Strong experience with ICD-10 coding and clinical documentation review.
• In-depth knowledge of medical terminology, anatomy, physiology, and disease processes.
• Expertise in HCC coding and risk adjustment programs.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills with the ability to educate audiences at all levels.
• Ability to manage multiple priorities and work independently in a remote environment.

Preferred Qualifications

• Current RN license in good standing.
• Certified Professional Coder (CPC) through AAPC.
• Minimum of 3 years of clinical experience, preferably in a Federally Qualified Health Center (FQHC) or primary care environment.
• Experience with Epic Electronic Medical Record (EMR) systems.
• Experience supporting value-based care and population health initiatives.

Why Join Us?

At our organization, you'll have the opportunity to make a meaningful impact on patient care while supporting a mission focused on improving community health. Your expertise will help ensure providers have the tools and knowledge needed to deliver high-quality, value-based care to the populations we serve.

What We Offer

• 100% Remote Work - Work from anywhere within the United States.
• 100% Employer-Paid Medical Insurance - Comprehensive medical coverage at no cost to employees on one of our health plans.
• Generous Paid Time Off (PTO) - Take the time you need to rest, recharge, and maintain work-life balance.
• 403(b) Retirement Plan with Employer Contribution - Invest in your future with retirement savings support.
• Professional Development & Education Assistance - Grow your skills through ongoing learning, certifications, and educational opportunities.
• Mission-Driven Culture - Join a team dedicated to strengthening community health and expanding access to quality healthcare services.

Disclaimer

At this time, Health Choice Network is not able to employ individuals who reside or work in California. Applicants must reside and perform work in an approved state at the time of hire and throughout employment.