The Role

As a member of the Medicare Risk Operations (MRO) team, the CDI specialist will be responsible for supporting Iora Health’s Medicare Risk Operations and Quality teams in reviewing concurrent and retrospective medical records to evaluate the completeness of outpatient provider documentation.

This role reports into the Director, Clinical Performance & Strategy in Boston, MA. The role is remote but must be located in one of the following states: MA, AZ, CO, TX, WA, NH, NC, & GA

Responsibilities:

• Reviews office notes of patients to identify the diagnoses in the HCC model and to assign a working HCC. Performs initial reviews, concurrent reviews and retrospective reviews to ensure there is adequate supporting documentation for HCC diagnoses in the note.
• Educates internal staff on clinical documentation and coding guidelines. Develops and conducts ongoing CDM education for new staff including coders, providers, nurses, and behavioral health specialists.
• Develops and supports strong professional relationships with medical providers across the system.
• Does review sessions with clinicians in local markets via video or face-to-face when possible.
• Utilizes a compliant query process per guidelines and policy when conducting all queries. Follows each query through to closure including complete documentation of ongoing follow up activities and communication.
• Prospectively generates suspect conditions based on findings from chart review and assists in the creation of decision support logic. 
• Works collaboratively with Medicare Risk Operations Medical Director to ensure positive program outcomes.
• Assists in other monitoring activities, special department projects or other needs as determined by the department manager.
• Provide ongoing CDI team learning opportunities through sharing of professional knowledge.
• Maintains integrity and compliance in all chart reviews and CDI documentation and queries at all times.
• Review medical records to identify documentation that supports closure of HEDIS and other quality gaps and with the CP+S/BCI teams to submit to health plans via attestation or electronic filings as appropriate.
• Works closely with Operations Director to implement MRO initiatives.

Qualifications

• Bachelor’s degree in Nursing, Health Information Management or other clinical degree preferred; however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements.
• Minimum 3 years related experience.
• CCS, CCDS or CDIP preferred.
• Knowledge of age-specific needs and the elements of disease processes and related procedures.
• Working knowledge of the Medicare Advantage reimbursement system and HCC Coding required.
• Working knowledge of HEDIS quality specification.
• Excellent written and verbal communication skills.
• Excellent critical thinking skills.
• Ability to work independently in a time-oriented environment.
• Tech savviness. Strong proficiency in Microsoft Windows, Word, Excel, PowerPoint and the Google suite of products, including Gmail and Calendar.

About Iora Health

Iora Health is transforming health care, starting with primary care. We created a high-impact relationship based care model, that particularly benefits adults on Medicare and those who might need more attention. Our care model changes everything - the team, outcome-focused payment, customer service, and the technology that supports our care.

We know that when you invest in relationships with people, you can help them live happier and healthier. Our patients get a team that respects and listens to them. We get paid to keep our patients healthier, and it works - we are successfully improving the lives of our patients while lowering costs.