Outpatient Clinical Documentation Specialist

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🕒 April 22

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Boston Medical Center (BMC)

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5001 - 10000 employees

Founded 1996

Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.

📋 Description

• Provide clinically based prospective, concurrent, and retrospective reviews of medical records for WellSense of members enrolled in value-based agreements • Review risk adjustment gap lists for members, including suspect conditions • Perform chart reviews to determine clinical validity of open gaps • Utilize Physician documentation queries to communicate clinical indicators to Physicians/Other Qualified Health Care Providers • Facilitate appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality • Track and Trend CDI findings and provider engagement for clinical documentation education purposes for any specialty within the hospital system

🎯 Requirements

• Bachelor’s degree in Nursing or Health Information Management is required • Minimum 5 years related experience working on the payer or provider side in Risk Adjustment Validation including prospective documentation reviews and pre-visit planning • Certified Risk Adjustment Coder required • Population Health experience, NCQA/HEDIS CDS experience preferred • Knowledge of care delivery documentation systems and related medical record documents • Excellent understanding of ICD10CM coding and guidelines • Ability to work independently in a time-oriented environment • Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes

🏖️ Benefits

• Health insurance • Discretionary annual bonuses • Merit increases • Flexible Spending Accounts • 403(b) savings matches • Paid time off • Career advancement opportunities • Resources to support employee and family well-being