Outpatient (RN) CDI Specialist

C002 Medical University Hospital Authority (MUHA); South Carolina; Hybrid; USD 95,000 - 125,000; Full time

Job summary

Medical University of South Carolina is seeking an Outpatient CDI Specialist who combines clinical documentation improvement with outpatient HCC coding. The role reports to the Outpatient CDI Program Manager and collaborates across providers, coding teams and care teams to improve documentation, risk capture and reimbursement.

The position requires a Bachelor’s in nursing, RN licensure, and at least five years of clinical nursing experience with strong communication skills.

Qualifications

• Bachelor's degree in nursing required; five years' clinical nursing preferred.
• Strong clinical and critical thinking skills required.
• Knowledge of patient care and clinical outcomes; ability to work with diverse teams.
• Licensed as a registered nurse by SC Board or compact state.

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.
• Query providers to address gaps for accurate coding and billing.
• Educate providers and staff on documentation best practices to improve encounter accuracy.
• Accurately assign ICD-10-CM for outpatient encounters and ensure coding accuracy meets 95%.

Skills

RN licensure

Clinical nursing

HCC coding

Communication with physicians

Education

Bachelor's degree in nursing

Tools

ICD-10-CM proficiency

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.

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 Work Shift

Minimum Education and Requirements

• Bachelor's degree in nursing from an accredited school of nursing and at least five years' clinical nursing experience preferred.
• 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.
• Licensure as a registered nurse by the South Carolina Board of Nursing or compact state.

Job Preference

• 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.

Preferred and Highly Encouraged 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.

Additional Job Description

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 on outpatient services.

Participate in ongoing education and stay current with changes in coding guidelines, CDI practices, and healthcare regulations.

Physical Requirements

• Mobility & Posture Standing: Continuous
• Sitting: Continuous
• Walking: Continuous
• Climbing stairs: Infrequent
• Working indoors: Continuous
• Working outdoors (temperature extremes): Infrequent
• Working from elevated areas: Frequent
• Working in confined/cramped spaces: Frequent
• Kneeling: Infrequent
• Bending at the waist: Continuous
• Twisting at the waist: Frequent
• Squatting: Frequent

Manual Dexterity & Strength

• Pinching operations: Frequent
• Gross motor use (fingers/hands): Continuous
• Firm grasping (fingers/hands): Continuous
• Fine manipulation (fingers/hands): Continuous
• Reaching overhead: Frequent
• Reaching in all directions: Continuous
• Repetitive motion (hands/wrists/elbows/shoulders): Continuous
• Full use of both legs: Continuous
• Balance & coordination (lower extremities): Frequent

Lifting & Force Requirements

• Lift/carry 50 lbs. unassisted: Infrequent
• Lift/lower 50 lbs. from floor to 36": Infrequent
• Lift up to 25 lbs. overhead: Infrequent
• Exert up to 50 lbs. of force: Frequent

Vision & Sensory

• Maintain corrected vision 20/40 (one or both eyes): Continuous
• Recognize objects (near/far): Continuous
• Color discrimination: Continuous
• Depth perception: Continuous
• Peripheral vision: Continuous
• Hearing acuity (with correction): Continuous
• Tactile sensory function: Continuous
• Gross motor with fine motor coordination: Continuous

Selected Positions

• Olfactory (smell) function: Continuous
• Respirator use qualification: Continuous
• Work Environment & Conditions Effective stress management: Continuous
• Rotating shifts: Frequent
• Overtime as required: Frequent
• Latex-safe environment: Continuous

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees

Thank you for wanting to be part of the Medical University of South Carolina team. Whether you want to teach the next generation of health care leaders, innovate new business models, discover the next breakthrough or provide patient care, there's a role for you that fuels your passion and takes advantage of your skills. There are career opportunities available in academics, research, hospital medicine, physician practices and support services, from patient billing to IT.

MUSC attracts more than $250 million annually in research funding, making it the biggest magnet for biomedical, extramural research dollars of all institutions of higher learning in South Carolina. The Clinical and Translational Science Award (CTSA) Program aims to advance clinical and translational science to increase the speed at which new treatments become available to patients. MUSC Health, the clinical enterprise, operates a 750 bed medical center, which includes a nationally recognized Children’s Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (one of fewer than 70 elite National Cancer Institute designated centers), a Level I Trauma Center and the Institute of Psychiatry. In addition, there are more than 100 outreach clinics, hospital/health system affiliations, and telehealth sites. U.S. News & World Report placed us among the top one percent of all American hospitals, with 11 specialties in the top 50. The MUSC Medical Center is also one of only three Magnet designated hospitals in South Carolina.