Outpatient CDI & HCC Coding Specialist

MUSC Health; South Carolina; Hybrid; USD 75,000 - 110,000; Full time

Job summary

Medical University Hospital Authority (MUHA) seeks an Outpatient CDI Specialist to enhance documentation quality and coding accuracy in outpatient settings. The role reports to the Outpatient CDI Program Manager and collaborates with clinicians, coders, and case managers to optimize reimbursement while reflecting patient severity.

The position requires an RN with 3+ years of clinical nursing experience and SC (or compact) licensure, plus knowledge of ICD-10-CM guidelines and HIPAA compliance.

Qualifications

• RN with at least 3 years of clinical nursing experience; CDI or coding experience preferred.
• Active nursing license in SC or compact state.
• Strong clinical knowledge and critical thinking; ability to collaborate with diverse teams.

Responsibilities

• Conduct concurrent and retrospective reviews to ensure documentation captures severity, risk, and medical necessity for outpatient services.
• Collaborate with physicians, nurse practitioners, case managers and coders to improve documentation and coding.
• Query providers clearly to address gaps and ambiguities to support accurate coding and billing.
• Educate providers and clinical staff on best practices for documentation to improve encounter accuracy and quality.
• Accurately assign ICD-10-CM for outpatient encounters and abstract data into EMR while complying with standards.
• Maintain data confidentiality and HIPAA compliance; ensure regulatory and payer compliance.
• Bridge communication between clinical staff and HIM; participate in provider education on coding standards.

Skills

Registered Nurse

HCC/Risk Adjustment experience

Documentation improvement

Communication with physicians

Education

Bachelor's degree in nursing

Tools

EMR systems

Job description

Medical University Hospital Authority (MUHA) seeks an Outpatient CDI Specialist to enhance documentation quality and coding accuracy in outpatient settings. The role reports to the Outpatient CDI Program Manager and collaborates with clinicians, coders, and case managers to optimize reimbursement while reflecting patient severity.

The position requires an RN with 3+ years of clinical nursing experience and SC (or compact) licensure, plus knowledge of ICD-10-CM guidelines and HIPAA compliance.