Hcc Coding Jobs in Virginia (NOW HIRING)

Job Description:

The Physician Advisor Services - CDI Specialist is responsible for improving the accuracy, completeness, and integrity of clinical documentation to ensure the medical record accurately reflects the patient's clinical status, supports optimal patient care, and fulfills regulatory, quality, and reimbursement requirements.
Through concurrent and retrospective review, this role applies advanced clinical judgment and knowledge of documentation standards to identify clinical indicators, clarify diagnoses with providers, and ensure proper capture of severity of illness, risk of mortality, and risk adjustment variables. The CDI Specialist partners closely with Clinical Documentation Integrity (CDI), Coding, Physician Advisors, Care Management, Quality, and regulatory teams to strengthen documentation performance across assigned facilities.

Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, Vermont, Washington.

Concurrent & Retrospective CDI Reviews

Performs comprehensive reviews of inpatient medical records to ensure documentation accurately reflects the patient's clinical presentation, diagnoses, treatments, and outcomes.

Identifies opportunities to improve capture of SOI, ROM, HCC, CC/MCC, DRG accuracy, and risk adjustment elements.

Ensures clinical documentation supports the acuity represented in coding and reimbursement methodologies.

Provider Engagement & Clinical Clarifications

Collaborates with physicians and advanced practice providers to clarify ambiguous, incomplete, or conflicting documentation.

Provides education on documentation best practices, clinical criteria, and regulatory expectations.

Utilizes compliant query practices according to industry standards.

Clinical Validation & Evidence-Based Criteria Application

Applies Intermountain clinical program criteria, service line guidance, and national evidence-based clinical indicators to validate diagnoses.

Identifies documentation that does not meet clinical validation standards and engages providers appropriately.

Supports documentation requirements for quality programs, infection prevention, patient safety, and publicly reported measures.

Collaboration With Coding, Physician Advisors, & Care Management

Works closely with coding professionals to ensure accurate DRG assignment and alignment of documentation with coded data.

Partners with Physician Advisors to review complex clinical scenarios, documentation gaps, and medical necessity considerations.

Collaborates with Care Management to supply patient data needed for Utilization Review, Conditions of Participation, and status determinations.

Quality, Risk Adjustment, & Regulatory Requirements

Evaluates documentation for impacts on mortality metrics, PSI/HAC, infection prevention, VBP, CMS Star Ratings, and other publicly reported outcomes.

Ensures documentation supports both commercial and government payer requirements.

Understands national HCC, RAF, DRG, and prospective payment methodologies.

Denials Prevention & Appeals Support

Identifies documentation gaps that may result in medical necessity or DRG-related denials.

Works with the Appeals Unit and Physician Advisors to support clinical appeal efforts and prevent payment denials.

Data, Analytics & Reporting

Maintains CDI metrics including accuracy rates, clarification trends, compliance issues, and documentation outcomes.

Contributes to dashboards and analytics that inform CDI and PAS program priorities.

Supports data abstraction requirements for internal and external reporting.

Skills

Hospital Care Experience

Clinical chart review

Regulatory Compliance

Regulatory Requirements

Quality Improvement Focus

Data Abstraction

Clinical expertise

Coding expertise

Publicly reported data requirements

Written and verbal communication

Interpersonal relationships

Minimum Qualifications

Degree in a clinical field (e.g. RN, RRT, LCSW). Education must be obtained through an accredited institution. Degree will be verified.

Three years of clinical experience in an adult acute care setting OR one year of experience as a Clinical Documentation Improvement Specialist in an adult acute care setting.

Proficiency in Quality and Infection Prevention reporting

Proficiency in Risk adjustment and Proactive Care Models

Preferred Qualifications

Experience with Microsoft Office products.
Clinical experience in ICU, CCU, primary care, or intermediate care.
Experience with Clinical Documentation Integrity.
Knowledge of EMR systems.

CCS, CIC, CCDS or CDIP

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

Location:

Peaks Regional Office

Work City:

Broomfield

Work State:

Colorado

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$42.66 - $65.82

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we usethe artificial intelligence ("AI") platform, HiredScore to improve your job application experience.HiredScore helps match your skills and experiences to the best jobs for you. WhileHiredScore assists in reviewing applications, all final decisions are made byIntermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.