Remote Outpatient CDI Specialist for Risk Adjustment

Reveleer; United States; Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical, Dental and Vision benefits

401k match

Generous PTO

Job summary

Reveleer is seeking a Clinical Documentation Specialist - Outpatient for a remote opportunity. The role focuses on reviewing patient records to identify and validate HCC diagnoses and to improve RAF score accuracy through provider queries and documentation improvements.

Ideal candidates will have nursing education, an active RN license, and CDI certifications (CDEO/CCDS-O/CDIP/CRC) with at least 2 years of outpatient CDI experience, navigating EMR systems like Epic, Athena, and Cerner.

Qualifications

• Graduate of an accredited nursing program with active RN license.
• Minimum of 2 years outpatient CDI experience.
• Certification: CDEO/CCDS-O/CDIP and CRC is required.

Responsibilities

• Identify gaps in documentation to improve quality and completeness.
• Validate recapture and suspect conditions with clinical evidence.
• Create queries reflecting best practice for documentation.
• Recommend improvements to clinical logic and workflows.
• Ensure confidentiality of patient information per privacy rules.
• Review patient records for accurate HCC diagnoses.

Skills

HCC knowledge

EMR navigation

Clinical terminology

Education

RN license

CDEO/CCDS-O/CDIP/CRC

Tools

Epic EMR

Athena EMR

Cerner EMR

Job description

Clinical Documentation Specialist- Outpatient

Remote Opportunity

About Reveleer

Reveleer delivers a unified platform spanningrisk adjustment,quality improvement,clinical intelligence, andmember managementfor health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence.

Summary/Objective

The clinical documentation specialist (Outpatient) is responsible for facilitating improvement in the overall quality and completeness of Clinical Intelligence’s recapture and suspecting performance. The specialist will perform reviews of patient records to identify and validate Hierarchical Condition Category (HCC) diagnoses. The specialist will query providers to ensure accurate and complete documentation that supports HCC and condition-related diagnoses, ultimately enhancing RAF score accuracy and improving risk adjustment outcomes.

Essential Functions

· Apply comprehensive knowledge of medical terminology, disease processes, treatment modalities, diagnostic tests, medications, and procedures to identify gaps in the overall quality and completeness of clinical documentation.

· Validate recapture and suspect conditions based on clinical evidence.

· Validate documentation supports reported conditions.

· Create queries reflective of best practice.

· Formulate recommendations to improve clinical logic and workflows.

· Maintain strict confidentiality of patient information in accordance with privacy regulations.

Competency

· Strong understanding of CMS, HHS, Medicaid, and Rx HCC models.

· Up to date with industry standards related to HCC documentation, ICD-10-CM coding, AHA Coding Clinics, and Official Coding Guidelines.

· Proficient in the use of electronic medical records and technology enabling solutions.

Required Education and Experience

· Graduate of an accredited nursing education program

· Active and unrestricted Registered Nurse or Advanced Practice Provider license

· Certified Documentation Expert-Outpatient (CDEO) or Certified Clinical Documentation Specialist- Outpatient (CCDS-O) or Certified Documentation Improvement Practitioner (CDIP) and Certified Risk Adjustment Coder (CRC)

· Minimum of 2 years outpatient CDI experience

· Experience navigating Epic, Athena, and Cerner EMRs

· 5 years of clinical experience

Preferred Education and Experience

· Bachelor’s Degree in Nursing preferred

· Ambulatory clinical experience preferred

WHAT YOU’LL RECEIVE

• Competitive salary

• Medical, Dental and Vision benefits

• 401kmatch

• Generous PTO plan

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.