Senior Clinical Documentation Integrity, Coding Specialist

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🗽 New York – Remote

🗽 New York – Remote

💵 $90.3k - $109k / year

⏰ Full Time

🟠 Senior

🏥📝 Medical Writer

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Nascentia Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1890

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare • Managed Long-Term Care

Nascentia Health is a healthcare organization dedicated to providing high-quality home and community-based care services for over 135 years. It specializes in managed long-term care, home health aides, and personal care assistance, while also offering Medicare Advantage Special Needs Plans for eligible individuals. Nascentia Health focuses on helping patients maintain their independence and access necessary services to stay safely in their homes.

📋 Description

• Review medical records to evaluate documentation completeness, clinical specificity, and coding accuracy • Validate ICD-10-CM, CPT, CPT II, and HCPCS coding against supporting clinical documentation and applicable coding guidelines • Identify missing, inconsistent, or unsupported documentation and recommend compliant clarification or correction • Conduct prospective and retrospective coding reviews • Support coding audits, documentation improvement initiatives, and regulatory compliance • Serve as an internal coding resource for clinical, quality, and operational teams • Support HEDIS medical record review, abstraction, and validation activities • Identify documentation supporting HEDIS measure compliance and appropriate gap closure • Review clinical records for services completed but not accurately represented in available clinical or claims data • Evaluate coding opportunities involving CPT II, procedure, and diagnosis codes relevant to quality reporting • Support supplemental data validation, medical record audits, and data reconciliation • Review medical records to validate risk-adjustable diagnoses and supporting clinical documentation • Identify documentation gaps, coding inaccuracies, and opportunities for compliant provider clarification • Support CMS-HCC coding accuracy and risk adjustment data integrity • Conduct prospective and retrospective risk adjustment reviews • Assist with risk adjustment audits, coding validation, and documentation improvement initiatives • Collaborate with provider-facing teams to strengthen documentation of chronic and complex conditions • Utilize Inovalon solutions to support HEDIS medical record retrieval and abstraction, clinical data validation, risk adjustment, and identification of coding and documentation opportunities • Support development of standardized workflows, provider education, and internal coding capabilities

🎯 Requirements

• Active CPC, CCS, CRC, or equivalent nationally recognized coding certification • Minimum 3–5 years of relevant experience in medical coding, clinical documentation improvement, risk adjustment, or clinical data validation • Strong knowledge of ICD-10-CM coding guidelines and clinical documentation requirements • Experience with Medicare Advantage, Managed Care, or Health Plan operations • Working knowledge of HEDIS quality measurement and CMS-HCC risk adjustment methodologies • Experience reviewing medical records for coding accuracy and documentation completeness • Strong analytical, communication, and problem-solving skills • Ability to work independently and collaborate across multiple departments • Hands-on experience with Inovalon solutions supporting both HEDIS and risk adjustment workflows • Experience with HEDIS medical record retrieval, abstraction, and validation • Familiarity with NCQA HEDIS specifications, CMS requirements, and audit processes • Experience supporting D-SNP or I-SNP populations • Knowledge of CPT II codes and quality-related claims reporting • CCDS, CDIP, or additional relevant certification • Experience with clinical data reconciliation, reporting, and workflow optimization • Ability to pass a pre-hire drug screen

🏖️ Benefits

• Retention bonuses • 401k with generous Employer match • Medical, Dental, Vision plans • Tuition Reimbursement for BSN after 6 months of employment • Exceptional work/life balance - no rotating shifts, holidays or weekends • Partially funded HSA • Employee Recognition Platform • Paid Time Off, Holidays, and Extended Sick Leave • Short/Long term Disability • Employee Assistance Program (EAP)

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