Outpatient Clinical Documentation Improvement Specialist

Joint Township District Memorial Hospital; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

Grand Lake Health System is seeking a Coding Specialist with expertise in documentation review and medical coding to ensure accuracy and compliance across ICD, CPT, HCPCS Level II, HEDIS CPT II, and RAF coding. The role emphasizes risk adjustment, quality reporting, and payer policy adherence.

Responsibilities include supporting clinicians, educators, and interdisciplinary teams to improve documentation quality, reduce denials, and align coding practices with federal regulations.

Qualifications

• Must have an associate degree in healthcare or related field.
• Must have training in medical terminology, anatomy, and physiology.
• Must have coding certification (CDEO, CCDS-O, CPC or CCS) or equivalent experience.
• Experience with medical documentation, coding guidelines, and payer policies.

Responsibilities

• Conduct core documentation review and ensure coding accuracy.
• Assess documentation for completeness and compliance with coding guidelines.
• Link provider documentation to ICD, CPT, HCPCS Level II, HEDIS CPT II, and RAF codes.
• Support risk adjustment reporting and quality initiatives.
• Educate providers and collaborate with coding, billing, and clinical staff.

Skills

Observation skills

Analytical thinking

Problem solving

Verbal and written communication

Presentation skills

Remote Teams communication

Education

Associate’s degree in Healthcare, Nursing or related field

Training in medical terminology, anatomy, physiology

Coding certification (CDEO, CCDS-O, CPC or CCS)

Tools

Coding encoders

Job description

Hours of Job Full-time, Salaried No Weekends or Holidays Required

Duties and Key Responsibilities

• In accordance with GLPP Coding policies and procedures, this specialist carries out these major and closely related duties and responsibilities: Core documentation review
• Assess documentation for completeness, specificity, and compliance with coding guidelines. Identify missing elements that impact code selection and medical necessity. Assist Providers in reconciling documentation to capture patient disease complexity during each visit (combination codes to reflect relationship between disease burden and disease complexity. Apply best practices for querying providers to ensure accurate documentation
• Outpatient coding and compliance
• Link provider documentation to ICD, CPT®, HCPCS Level II, HEDIS (CPT II), and Risk Adjustment Factor (RAF) code assignment. Review E/M documentation requirements, including medical decision making and time based coding, provide guidance on documentation improvement opportunities. Ensuring compliance with payer policies, NCCI edits, and federal regulations.
• Risk adjustment and quality reporting Understand documentation requirements for HCC, HEDIS (CPT II) and Risk Adjustment Factor (RAF) coding. Support accurate reporting for quality initiatives and value-based care. Identify documentation gaps that affect population health and reimbursement.
• Communication and provider education Provide feedback to providers on documentation deficiencies (including attendance of POC meetings). Educate clinicians on best practices for supporting coding and audit readiness. Enhance collaboration between coding, billing, and clinical staff to reduce denials and compliance risk.

Requirements

• Should be knowledgeable in use of coding software (encoders).
• Should be knowledgeable in LDC/NCD (or how to look this up) and Quality Measures.
• Should be knowledgeable in coding guidelines.
• Requires excellent observation skills, analytical thinking, problem solving, plus excellent verbal/ written and presentation skills. Must have the ability to balance and juggle multiple tasks, projects, and requests; meet deadlines.
• Ability to communicate effectively via remote Teams application.
• Manual and finger dexterity. Sitting for extended periods of time. Ambulate to provider practices or group meetings, as needed. Requires corrected vision and hearing to normal range. Requires working under stressful conditions.

Education/Certifications

• Must have an Associate’s degree in Healthcare, Nursing or related field, or equivalent combination of education & experience.
• Must have training in medical terminology, anatomy, and physiology.
• Must have training and certification in coding, or equivalent combination of education and experience.
• Must possess a certification; Certified Documentation Expert Outpatient (CDEO), Certified Clinical Documentation Specialist-Outpatient (CCDS-O), or Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) with coding or clinical documentation integrity experience. Must agree to obtain CDEO or CCS-O within first year of employment.

Experience

• In-depth knowledge of medial record content. In-depth knowledge of coding/classification systems (ICD & CPT) and associated coding guidelines. Experience with compliant healthcare documentation, HCC coding requirements, alternate payment models in a multi-facility, revenue cycle experience. Basic computer skills.

Grand Lake Health System provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. GLHS complies with applicable state and local laws governing nondiscrimination in employment in all of our locations.

Grand Lake Health System is an At-Will Employment employer. As a regional healthcare leader, Grand Lake Health System integrates compassionate care, advanced technology and exceptional expertise to provide comprehensive primary, acute and therapeutic services. Focused on accessibility, quality and innovation, the organization is dedicated to meeting the healthcare needs of the Grand Lake region and surrounding communities.