Ambulatory Clinical Documentation Integrity Specialist (Remote)
Trinity Health
Livonia, MI
Employment Type Full time Shift Description: Purpose Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge. Essential Functions Our Trinity Health Culture : Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. Data Management & Analysis Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role (not inclusive of titles or advancement career progression)
- Obtain appropriate clinical documentation through extensive interaction with providers and coding staff to ensure documentation reflects level of service rendered to patients is complete and accurate.
- Validate the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians & advanced practice providers.
- Conduct thorough prospective & sometimes retrospective quality reviews of ambulatory patient records, documenting all relevant findings & tracking key information through the process.
- Identify areas where documentation requires clarification & engagement with physicians, advanced practice providers & other healthcare professionals to effectively resolve discrepancies.
- Ensures medical record documentation is accurate, complete, & compliant, supporting acute or chronic conditions & medical necessity.
- Applies through understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment, ensuring compliance with reporting standards for claims submission.
- Identifies patterns & trends impacting documentation & coding & acts as a technical resource related to documentation, coding & billing regulations for assigned service area.
- Associate’s degree in Business, healthcare, Nursing or related field, or equivalent combination of education & experience
- Experience with compliant healthcare documentation, HCC coding requirements, alternate payment models in a multi-facility, integrated health care delivery system, revenue cycle or consulting experience.
- Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Integrity (CDI), Certified Clinical Documentation Specialist – Outpatient (CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Integrity Practitioner (CDIP) credential with coding or clinical documentation integrity experience.
- Bachelor’s degree in nursing, HIM or related healthcare field.
- Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
- Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
- Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
- Exposure to interruptions, shifting priorities & stressful situations. Frequent
- Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Continuous
- Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent
- Perform manual dexterity activities & / or grasping / handling. Occasional
- Ability to climb, kneel, crouch & / or operate foot controls. Occasional
- Use a computer / other technology. Frequent
- Sit with the ability to vary / adjust physical position or activity. Continuous
- Maintain a safe working environment & use available personal protective equipment (PPE). Continuous
- Comply with applicable Code of Conduct, policies, procedures & guidelines. Continuous
- Ability to provide assistance in the event of an emergency. Occasional
- Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Frequent
- Lift a maximum of 30 pounds unassisted. Occasional
- Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional
- Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
- Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional
- Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional
- Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
- Lift a maximum of 30 pounds unassisted. Occasional
- Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
- Encounter a clinical / patient facing / hands on interactive work environment. Occasional
- Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
- Work outdoors with variable external environmental conditions. Occasional
Posted 2026-01-08
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