The Clinical Coding/Documentation Improvement Specialist is responsible for monitoring and auditing medical record documentation, coding, quality measures, utilization, and billing within practice offices. This role requires knowledge of 5 STAR, PQRS, HEDIS, CMS coding and billing guidelines, clinical standards, and outcomes management.

Responsibilities include auditing documentation, coding, and billing practices, ensuring compliance with current coding guidelines, querying providers for coding specificity, maintaining chronic condition lists for PCPs, supporting quality measure initiatives, analyzing utilization practices, assisting care coordination, teaching proper documentation and coding guidelines, reporting issues to relevant departments, and supporting various quality improvement projects.

Candidates should have a clinical background and current ICD-10 coding certification or equivalent, with 1-2 years of medical coding experience or demonstrated proficiency. Certification as CPC is required within 1 year of hire.

Computer skills required include proficiency with Microsoft Word, Excel, internet, email, and insurance websites. Good communication and problem-solving skills are essential. The work environment is moderate noise level with physical demands including sitting, using hands, talking, and hearing.