CDI Risk Adjustment Specialist

CDI Risk Adjustment Specialist

remote type

Remote

locations

Somerville-MA

time type

Full time

job requisition id

RQ4038102

Site: Mass General Brigham Incorporated
 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
 

Job Summary

The CDI Risk Adjustment Specialist reports to the Senior Manager, CDI Risk Adjustment and conducts advanced second level clinical documentation reviews for inpatient encounters focusing specifically on documentation opportunities supporting risk-adjusted methodologies to accurately reflect the quality of care being delivered across MGB. This role focuses on improving quality outcomes through improvement of risk-adjusted reporting impacting the O/E for multiple MGB enterprise quality initiatives while adhering to CDI established policies, procedures, and professional guidelines.

Principle Duties and Responsibilities

· Perform Risk Adjustment CDI reviews to identify discrepancies or missed opportunities in clinical documentation that impact quality outcomes through risk-adjusted measures, specifically Vizient and Elixhauser variables.

· Accurately interpret clinical information in the health record and evaluate clinical indicators to identify potential diagnoses and query opportunities impacting quality outcomes.

· Issue clinically credible and compliant queries to providers as appropriate with focus on addressing organizational quality initiatives.

· Escalate complex cases to the CDI leadership team or physician advisors, as needed.

· Track and report clinical documentation or CDI issues affecting quality measures.

· Maintain up-to-date knowledge of CDI practices, inpatient coding guidelines, CMS/OIG regulatory changes, and AHA Coding Clinic.

· Work collaboratively with vendor-supported primary CDI Specialist workforce to ensure accurate clinical documentation and appropriate principal diagnosis assignment for all reviewed encounters.

· Meet or exceed MGB CDI Risk Adjustment Specialist key performance indicators.

· Use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

· Other duties as assigned
 

Qualifications

• Registered Nurse (RN), Advanced Practice Clinician (NP/PA), or other clinically licensed professional
• 5 years of acute medical/surgical care experience required
• 3-5 years of advanced clinical documentation improvement experience required
• Certification in Clinical Documentation preferred

 

Skills Abilities, and Competencies

 

• In-depth knowledge of clinical disease processes and inpatient care delivery
• Demonstrated proficiency in risk-adjustment CDI knowledge, specifically Vizient and Elixhauser methodologies
• Advanced understanding of risk adjustment methodologies impacted by clinical documentation.
• Can explain observed-to-expected ratios and their calculation
• Advanced understanding of MS-DRG/APR-DRG logic, SOI/ROM methodology, and CC/MCC assignment
• Strong analytical, critical thinking, and clinical reasoning skills
• High attention to detail and commitment to accuracy and compliance
• Excellent written and verbal communication skills
• Proficiency in CDI software systems to document, track, report outcomes and interact with coding professionals
• Knowledgeable about current CDI industry trends
• Proactive in researching and resolving clinical and CDI questions
• Self-driven, able to prioritize tasks, and adapt quickly to change
• Dedicated to continuous learning and professional growth
• Team-oriented with strong collaboration skills

Additional Job Details (if applicable)
 

Remote Type

Remote
 

Work Location

399 Revolution Drive
 

Scheduled Weekly Hours

40

Employee Type

Regular
 

Work Shift

Day (United States of America)
 

Pay Range

$78,000.00 - $113,453.60/Annual
 

Grade

7

 

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
 

EEO Statement:

Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

 

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.