Outpatient CDI Specialist-1

musc; United States; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Medical University Hospital Authority (MUHA) seeks an Outpatient CDI Specialist to join a hybrid role combining CDI and outpatient HCC coding. The role reports to the Outpatient CDI supervisor and aims to enhance documentation accuracy, quality, and completeness in outpatient medical records while ensuring coding guidelines are followed.

The position collaborates with providers, coding teams, and healthcare professionals to optimize reimbursement and reflect true severity of illness and care.

Qualifications

• Bachelor's degree in nursing and RN licensure with 3+ years of clinical/ CDI experience preferred.
• Active RN licensure by SC Board or compact state is required.
• Experience in outpatient CDI or HCC coding preferred.

Responsibilities

• Conduct concurrent and retrospective reviews to capture full patient severity and medical necessity for outpatient services.
• Collaborate with physicians, nurse practitioners, case managers, and coders to improve documentation.
• Query providers to address documentation gaps supporting accurate coding and billing.
• Educate providers and staff on best practices for documentation to improve accuracy.
• Assign ICD-10-CM codes for outpatient encounters and ensure compliance with guidelines.
• Abstract data into EMR while adhering to coding standards and regulatory requirements.
• Maintain confidentiality and HIPAA compliance in all documentation activities.

Skills

Clinical knowledge

Communication skills

Critical thinking

Team collaboration

Education

Bachelor's degree in Nursing

Registered Nurse license (SC Board or compact state)

Tools

ICD-10-CM proficiency

EMR systems

Job description

Job Description Summary

The Outpatient CDI Specialist is a hybrid role that combines the expertise of clinical documentation improvement (CDI) and outpatient Hierarchical Condition Category (HCC) coding. This position will report to the Outpatient CDI Program Manager. This position focuses on improving the accuracy, quality, and completeness of clinical documentation in outpatient medical records while ensuring compliance with coding guidelines. The specialist will work collaboratively with providers, coding teams, and other healthcare professionals to facilitate accurate coding, improve risk capture, and optimize reimbursement while reflecting the true severity of illness and care provided.

The Outpatient CDI Specialist is a hybrid role that combines the expertise of clinical documentation improvement (CDI) and outpatient Hierarchical Condition Category (HCC) coding. This position will report to the Outpatient CDI supervisor and will focus on improving the accuracy, quality, and completeness of clinical documentation in outpatient medical records while ensuring compliance with coding guidelines. The specialist will work collaboratively with providers, coding teams, and other healthcare professionals to facilitate accurate coding, improve risk capture, and optimize reimbursement while reflecting the true severity of illness and care provided.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC005475 SYS - Outpatient CDI Program

Pay Rate Type

Salary

Pay Grade

Health-28

Scheduled Weekly Hours

40

Job Description

The Outpatient CDI Specialist is a hybrid role that combines the expertise of clinical documentation improvement (CDI) and outpatient Hierarchical Condition Category (HCC) coding. This position will report to the Outpatient CDI supervisor and will focus on improving the accuracy, quality, and completeness of clinical documentation in outpatient medical records while ensuring compliance with coding guidelines. The specialist will work collaboratively with providers, coding teams, and other healthcare professionals to facilitate accurate coding, improve risk capture, and optimize reimbursement while reflecting the true severity of illness and care provided.

Minimum Qualifications

• Education and Experience Requirements: Bachelor's degree in nursing from an accredited school of nursing and at least three years' clinical nursing experience preferred.
• Licensure as a registered nurse by the South Carolina Board of Nursing or compact state.
• Strong clinical experience and critical thinking skills required.
• Extensive knowledge of patient care, and knowledge of clinical measurement tools and clinical outcomes.
• Ability to establish cooperative working relationships with diverse groups and individuals, medical staff and other health care disciplines.

Experience

• Job Specifications: Registered Nurse with at least 3 or more years of experience either in the clinical field, CDI field, or coding.
• 1 or more years of experience in HCC/Risk Adjustment preferred.
• Minimum of 3 years of experience in clinical documentation improvement, outpatient Hierarchical Condition Category (HCC), or a combination of both preferred.
• Experience in an outpatient or acute care setting required.
• Ability to work independently, be resourceful, and possess strong organizational skills.
• Ability to communicate effectively with physicians and other clinical staff; be courteous and professional.

Required Certifications/Licensure

• Active certification from one of the following preferred: AAPC (Certified Professional Coder - CPC, Certified Risk Adjustment Coder - CRC or Certified Documentation Expert - Outpatient CDEO)
• AHIMA (Certified Coding Specialist - CCS or Certified Documentation Improvement Practitioner - CDIP)
• ACDIS (Certified Clinical Documentation Specialist - CCDS or CCDS-O)
• Candidates without a certification must obtain one within the first year of employment.
• Proficiency in ICD-10-CM preferred.

Job Responsibilities

• Clinical Documentation Improvement: (50%) Conduct concurrent and retrospective reviews of medical records to ensure clinical documentation captures the full scope of patient severity, risk of mortality and medical necessity for outpatient services.
• Collaborate with physicians, nurse practitioners, case managers and coders to identify opportunities for improving documentation of diagnoses, procedures and medical necessity.
• Query providers in a compliant and clear manner to address documentation gaps, ambiguities or discrepancies to support accurate coding and billing.
• Educate providers and clinical staff on best practices for documentation to improve encounter accuracy and quality.
• Outpatient HCC Coding: (25%) Accurately assign ICD-10 CM for outpatient encounters, including clinical visits, emergency department visits, ambulatory surgeries, laboratory services and observation care.
• Abstract data and input into electronic medical record systems while adhering to organizational and regulatory coding standards.
• Ensure coding accuracy meets or exceeds a 95% accuracy rate, following official ICD-10-CM guidelines.
• Data Integrity and Compliance (15%): Maintain complete confidentiality of patient information and adhere to HIPAA regulations and organizational policies.
• Ensure documentation and coding practices meet compliance standards for regulatory and payer requirements.
• Collaboration and Education (10%): Act as a liaison between clinical providers and HIM to bridge the gap between documentation and coding requirements.
• Participate in education for providers on coding and documentation standards, focusing