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Member Liaison Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Member Liaison Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our CS - Member Liaison team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. You will also serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - Member Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.</li>
<li>Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.</li>
<li>Coordinates members' health care and social service needs within and outside the health network and CalOptima Health during the original interaction.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.</li>
<li>Guides members in understanding and accessing the benefits under the Whole-Child Model program.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Initiates referrals to internal and external care management departments and government agencies.</li>
<li>Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Collaborates with interdepartmental staff in call resolution as needed.</li>
<li>Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.</li>
<li>Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience as a call center agent or customer/member services representative in health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. </li>
<li>Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757493&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 9, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6757493" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-505-city-parkway-west-california-united-states-33e8b0be-b4dd-42d0-9530-e2df2d63a939</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-537ce69475a85e4fb5e079ee955c18f2

Member Liaison Specialist (Customer Service)

<h3>Job Description</h3>
Job DescriptionCompany Description 
The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team.&nbsp;
Job Description 
This role is based out of UM Capital Region Medical Center
<ol>
<li>DOCUMENTATION: Facilitates initial assessment of the quality of clinical documentation for all types of patients. Reviews relevant sections of the record and develops a documentation improvement plan consistent with the clinical picture of each patient.</li>
<li>TEAMWORK: Engages in face-to-face time with physicians; describes what documentation is necessary for accurate coding; explains benefits of accurate/timely clinical documentation. Provides leadership and facilitates multidisciplinary discussions regarding documentation improvement. Assists in correcting knowledge deficits on part of physicians and other staff members. Assumes a leadership role in continual assessment of the quality of documentation and identifies opportunities for improvement. Organizes and participates in training and CDI program promotional activities for physicians and staff.</li>
</ol>
Qualifications 
<ul>
<li>4 year / Bachelor’s Degree: Nursing (required)</li>
<li>Master’s Degree (preferred)</li>
<li>Registered Nurse Certified (required)</li>
<li>RHIA, RHIT (preferred)</li>
<li>4 - 6 years Clinical Nursing, or Health Information Management experience (required)</li>
<li>6 - 9 years Clinical Nursing, or Health Information Management experience (preferred)</li>
<li>Required Skills: Strong Verbal Communications Skills, Basic Computer skill</li>
</ul>
 Additional Information 
All your information will be kept confidential according to EEO guidelines.
Compensation: Pay Range:&nbsp;$38.67-$58.05 Other Compensation (if applicable): Review the 2025-2026 UMMS Benefits Guide
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at <a href="mailto:careers@umms.edu" target="_blank">careers@umms.edu</a>.

Clinical Documentation Specialist

<h3>Job Description</h3>
Job DescriptionCompany Description 
The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team.&nbsp;
Job Description 
<ol>
<li>DOCUMENTATION: Facilitates initial assessment of the quality of clinical documentation for all types of patients. Reviews relevant sections of the record and develops a documentation improvement plan consistent with the clinical picture of each patient.</li>
<li>TEAMWORK: Engages in face-to-face time with physicians; describes what documentation is necessary for accurate coding; explains benefits of accurate/timely clinical documentation. Provides leadership and facilitates multidisciplinary discussions regarding documentation improvement. Assists in correcting knowledge deficits on part of physicians and other staff members. Assumes a leadership role in continual assessment of the quality of documentation and identifies opportunities for improvement. Organizes and participates in training and CDI program promotional activities for physicians and staff.</li>
</ol>
Qualifications 
<ul>
<li>4 year / Bachelor’s Degree: Nursing (required)</li>
<li>Master’s Degree (preferred)</li>
<li>Registered Nurse Certified (required)</li>
<li>RHIA, RHIT (preferred)</li>
<li>4 - 6 years Clinical Nursing, or Health Information Management experience (required)</li>
<li>6 - 9 years Clinical Nursing, or Health Information Management experience (preferred)</li>
<li>Required Skills: Strong Verbal Communications Skills, Basic Computer skill</li>
</ul>
 Additional Information 
All your information will be kept confidential according to EEO guidelines.
Compensation: Pay Range:&nbsp;$38.67-$58.05 Other Compensation (if applicable): Review the 2025-2026 UMMS Benefits Guide
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at <a href="mailto:careers@umms.edu" target="_blank">careers@umms.edu</a>.

<h3>Job Description</h3>
Job Description
Make it Happen at Hopkins!
Join our Team | Apply NOW | Hiring for Experienced Clinical Documentation Specialist
PLEASE NOTE: This position requires a Certified Professional Coder (CPC) or Certified Risk Adjuster Certification (CRC)
At Johns Hopkins Community Physicians (JHCP), we bring the excellence of Johns Hopkins Medicine to our communities. With over 40 locations across Maryland, Virginia, and Washington, DC, your next incredible career opportunity is right in your neighborhood. 
As a Clinical Documentation Specialist, you’ll play a critical role in improving the quality and accuracy of inpatient medical records. By collaborating with physicians and staff, you’ll ensure proper documentation for coding, risk, and severity assessments.
If you are an RN, PA, NP, Foreign Medical Graduate or M.D., with the following experience, license, and certifications, APPLY NOW!
Qualifications
<ul>
<li>Education: Completion of an accredited advanced clinical program (RN with BSN or higher, AMA-approved Physician Assistant program, or other advanced medical training such as MD-BS). Master’s or Doctoral degree (MSN, DNP) preferred.</li>
<li>Licensure/Certification:</li>
<ul>
<li>Current RN license (MD or compact state), PA license (NCCPA certified), or other advanced medical degree.</li>
<li>CPC or CRC - Advanced clinical documentation certification and/or risk adjustment certification (AAPC or AHIMA) required.</li>
</ul>
</ul>
Work Experience:
<ul>
<li>RN: Requires a minimum of 3 years Registered Nurse clinical experience in healthcare setting. Minimum of 2 years as a Clinical Documentation Specialist. In lieu of healthcare setting experience, a minimum of 3 years of CDI experience, and/or other relevant clinical experience may be considered. </li>
<li>PA or NP: Requires a minimum of 3 years Physician Assistant or NP experience in a healthcare setting. Minimum of 2 years as a Clinical Documentation Specialist. In lieu of healthcare setting experience, a minimum of 3 years of CDI experience, and /or other relevant clinical experience may be considered</li>
<li>Other Advanced Clinical Degree (i.e. MD or MD-BS): Minimum of 3 years' experience in a healthcare setting. Minimum of 2 years of Clinical Documentation Improvement experience preferred.</li>
</ul>
Why Choose JHCP? When you join our team, you’ll enjoy:
<ul>
<li>Comprehensive Benefits: Medical, dental, and vision insurance.</li>
<li>403B savings plan with employer contributions.</li>
<li>Work-Life Balance: Generous paid time off and holidays.</li>
<li>Tuition Assistance: Employee and dependent education benefits.</li>
<li>Free parking</li>
<li>Extra Perks: Referral bonuses and health &amp; wellness programs.</li>
</ul>
Position Details
<ul>
<li>Shift: Full-Time, Day Shift (40 hours/week) - Monday - Friday</li>
<li>Location: Fully Remote (must reside or relocating to the following states within 90 days of hire): MD, DC, VA, PA, DE, and FL</li>
</ul>
For any questions, please email Radina Haggard @<a href="mailto:rhaggar3@jh.edu" target="_blank">rhaggar3@jh.edu</a> 
Salary Range: Minimum 38.49/hour - Maximum 59.66/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.
In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins! 
Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.

CLINICAL DOCUMENTATION SPECIALIST

<h3>Job Description</h3>
Job DescriptionDepartment: Health Information Management Schedule/Status: 7:30am -4pm; Full Time Standard Hours/Week: 40 General Description: Under the general supervision of the Director of HIM, the Clinical Documentation Specialist (CDS) is responsible for coordinating the review of concurrent inpatient clinical documentation and data. The CDS facilitates accurate documentation for severity of illness and quality documentation in the medical record. This involves extensive record review, interaction with physicians, health information management professionals, clinical informatics, and nursing staff. The CDS works with providers to ensure clinical disease processes are accurately documented and that the documentation appropriately reflects the patients severity of illness and DRG. Active participation in team meetings and education of staff in the CDI process is a key role. Key Responsibilities: 
<ul>
<li>Analyzes documented data and information to assist in determining areas for improvement in documentation and proper DRG selection. Provides concurrent reviews of inpatient medical records, identify potential documentation deficits, and clarifies with providers (physicians, PAs, ARNPs, etc.) to ensure the appropriate severity of illness is documented.</li>
<li>Has a working knowledge of correct principal diagnosis and principal procedures. Understands ICD-10 coding and DRG principles in accordance with coding and reimbursement guidelines. Is able to validate DRG grouping and relate grouping methodology to documentation needs.</li>
<li> Utilizes documentation software and EMR templates to maintain accuracy of data for tracking purposes.</li>
<li>Formulates appropriate documentation clarification queries using established guidelines to clarify questionable or incomplete documentation.</li>
<li>Identifies clinical or system/process breakdowns and improvement opportunities and refers them to the appropriate areas (CM, Risk, Quality) for resolution.</li>
<li>Acts as a documentation resource for Nursing, Case Managers, Coding, and Physicians. Actively participates in the education of healthcare team members on current healthcare economic issues impacting practice patterns, reimbursement and positive patient outcomes.</li>
<li> Attends professional in-services and coding in-service programs.</li>
<li>Participates on hospital committees as assigned. Performs similar or related duties as assigned. Knows fire, disaster and safety procedures and regulations as pertains to the work area.</li>
</ul>
Requirements: Formal Education: 
<ul>
<li>Associates degree, or other two year college equivalent. Major required: Nursing. Graduate of an accredited RN Education Program, BSN preferred </li>
</ul>
Work Experience: 
<ul>
<li> Minimum of five (5) years nursing experience in Med/Surg., Critical Care, or similar nursing experience.</li>
</ul>
Required Certifications / Licenses: 
<ul>
<li>State of Florida RN license. ICD-10 training and certification preferred.</li>
<li>Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) credentials preferred.</li>
</ul>
Full Time Benefits: Eligible to participate in a number of PMC-sponsored benefits, including: 
<ul>
<li>Benefits Start on Day 1</li>
<li>Health, Dental and Vision Insurance</li>
<li>403(b) Retirement Program</li>
<li>Tuition Reimbursement/Educational Assistance</li>
<li>EAP, Flex Spending, Accident, Critical and Other Applicable Benefits</li>
<li>Annual Accrual of 152 Personal Leave Bank (PLB) Hours</li>
</ul>

<h3>Job Description</h3>
Job DescriptionThe Clinical Documentation Integrity Specialist (CDIS) plays a vital role in ensuring the precision and completeness of clinical documentation and coding to optimize patient data accuracy. This position involves performing both retrospective and prospective chart reviews. The CDIS will conduct provider education and training related to complete and accurate diagnostic documentation and coding, in accordance with ICD-10 CM coding guidelines, internal protocols and CMS and payer guidelines. The CDIS will deliver tailored education at the individual provider-level; complete end-to-end workflow assessment and optimization; and perform chart reviews to identify specific opportunities for improved accuracy. There will be opportunity to travel periodically to practices as well as engage in remote work.&nbsp; The CDIS must be detail-oriented, service-minded, possess strong verbal and written communication skills, and be fluent in (or willing and able to master) Google Suite tools.Primary Duties:
<ul>
<li>Perform chart reviews to identify opportunities for better accuracy in clinical documentation and coding.&nbsp; Evaluate and optimize end-to-end practice clinical documentation, billing and coding workflows. Develop and implement action plans to improve the completeness and accuracy of clinical documentation and coding </li>
<li>Work directly with Aledade practices and providers on continuous improvement of complete and accurate documentation and diagnosis coding. Facilitate clinical documentation and coding communication amongst key internal and external stakeholders. Provide guidance to field staff and practices regarding general documentation and coding best practices and risk adjustment</li>
<li>Deliver internal and external-facing education and training on clinical documentation and diagnosis coding to support value-based contracts.</li>
</ul>
Minimum Qualifications:
<ul>
<li>Bachelor’s degree in a healthcare related field or equivalent work experience required</li>
<li>Current certification as a Certified Professional Coder (CPC), or equivalent</li>
<li>Certified Documentation Expert Outpatient (CDEO®) from AAPC or Certified Clinical Documentation Specialist-Outpatient (CCDS-O) from ACDIS.</li>
<li>3+ years of recent, relevant work experience in CDI or 5+ years as a risk adjustment auditor; 3+ years RCM or billing experience</li>
<li>Familiarity with anatomy and physiology, disease processes and medical terminology</li>
<li>Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models</li>
<li>Subject matter expertise on the CMS HCC Risk Adjustment program, methodology, and impact to value-based contracts</li>
<li>Ability to identify and communicate opportunities to improve documentation and diagnosis capture for accurate risk adjustment coding</li>
<li>Experience working directly with physician practices and individual providers to achieve demonstrable improvement in increasing the accuracy and completeness of documentation and diagnosis coding</li>
</ul>
Preferred Qualifications:
<ul>
<li>Successful track record in outpatient coding and billing through previous experience</li>
<li>Self-directed and solution oriented</li>
<li>Strong understanding of value-based care principles, particularly as they relate to the impact of clinical documentation and coding on risk adjustment payment models in value-based contracts</li>
<li>Strong understanding of outpatient coding and billing</li>
<li>Solution-oriented individual who can execute tactical continuous quality improvement work to deliver results in value-based contracts</li>
<li>Excellent communicator who can articulate the impact of documentation and diagnosis initiatives to Aledade ACO member practices and their key staff (e.g., office managers, practice billers, etc.), and internally within the company. </li>
<li>Ability to work collaboratively across Aledade clinical and non-clinical teams to gain buy-in and implement key documentation improvement initiatives</li>
<li>References demonstrating high degree of integrity and professional accountability</li>
</ul>
Physical Requirements:
<ul>
<li>Prolonged periods of sitting at a desk and working on a computer</li>
</ul>

Clinical Documentation Integrity Specialist

<h3>Job Description</h3>
Schedule: Full Time Weekdays.
Location: This is an on-site position located at Raleigh General Hospital.
Your experience matters 
Raleigh General is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Scheduler - Advanced Surgery, you're embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. 
How you'll contribute 
A Clinical Documentation Specialist RN who excels in this role:
<ul>
<li>Ensures comprehensive medical record documentation that reflects the clinical treatment, decisions, and diagnosis for all inpatients through concurrent interaction with physicians, case managers, coders, and other health team members.</li>
<li>Conducts daily reviews of inpatient medical records to identify missing, vague, and/or incomplete diagnoses and procedures. Conducts timely follow-up reviews of clinical documentation to ensure that issues discussed and queries left in the medical record have been answered by the provider.</li>
<li>Utilizes coding and clinical expertise to identify opportunities and ensure the accuracy and completeness of clinical documentation used for measuring and reporting physician and hospital outcomes.</li>
<li>Queries physicians on specificity of procedures performed and diagnoses based on accepted coding guidelines, clinical expertise and LifePoint Hospitals query policy.</li>
<li>Tracks and trends specific opportunities for CDI process improvement through the utilization of metrics reports.</li>
</ul>
What we're looking for Qualified applicants must have a valid West Virginia Registered Nurse license. Additional requirements include:
<ul>
<li>Associate's degree in nursing is Required. </li>
<li>Bachelor's degree in Nursing is preferred.</li>
<li>RHIA, RHIT, CCDS, or CDIP certification is preferred.</li>
</ul>
Why join us 
We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: 
<ul>
<li>Comprehensive Benefits:Multiple levels of medical, dental and vision coverage for full-time andpart-time employees. </li>
<li>Financial Protection &amp; PTO:Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. </li>
<li>Financial &amp; Career Growth:Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. </li>
<li>Employee Well-being:Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). </li>
<li>Professional Development:Ongoing learning and career advancement opportunities. </li>
</ul>
More about Raleigh General Hospital
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Raleigh General Hospital is a 300 bed facility caring for nearly 13,000 patients each year with over 50,000 being treated in our emergency room. We offer a wide range of surgical services as well as specialty programs including Cardiac CTA, Digital Mammography, and Trauma Services. 
Raleigh General Hospital is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

Clinical Documentation Specialist (CDIS) RN

<h3>Job Description</h3>
Job Description
Monday-Friday 8-430 
This position requires you to be onsite. 
Title: Clinical Documentation Specialist (CDS) Nurse-Safety Sensitive 
Department: Case Management

Reporting Relationships: Case Management Lead
 Case Management Supervisor
 Executive Director of Quality
Job Summary: The CDS will facilitate modifications to clinical documentation via compliant query practices. The CDS will utilize extensive concurrent and retrospective medical record reviews and collaborate with providers to reflect appropriate clinical severity, complications, and co-morbidities for the purpose of maintaining quality, integrity, complete and accurate information that is reportable through the ICD-10 coding system. 

Job Duties: 
<ul>
<li>Consistently complies with the guidelines set forth by accrediting bodies. </li>
<li>Reviews medical records of hospitalized patients to identify the most appropriate principle diagnosis and assign a working DRG. </li>
<li>Performs concurrent and retrospective reviews of medical record, to ensure the provider documentation is complete, accurate, and clear, while capturing associated co-morbidities.</li>
<li>Develops and conducts ongoing CDI education for members of the healthcare team. </li>
<li>Utilizes compliant query process per guidelines and policy when conducting all queries. </li>
<li>Support and implement quality measures as identified by department manager. </li>
<li>Help identify opportunities for performance improvement. </li>
<li>Utilize Iodine CDI software to guide prioritization of CDI reviews and identifying documentation opportunities. </li>
<li>Performs other duties as assigned by supervision. </li>
</ul>

Qualifications:
<ol>
<li>Education:</li>
</ol>
● RN licensure required. (Bachelor’s preferred). 
● BLS required.
<ol>
<li>Training and Experience: </li>
</ol>
● 3-5 years clinical experience preferred
<ol>
<li>Job Knowledge: </li>
</ol>
● Knowledge of compliant query practices. 
● Demonstration of effective problem-solving techniques including conflict management skills
● Demonstration of excellent oral and written communication skills
● Excellent organizational and record-keeping skills, as well as the ability to manage multiple cases
● Completes responsibilities in a timely manner through effective organization, setting priorities, delegation, and time management skills
● Maintains integrity, confidentiality, and ensures compliance with WRMC’s policies and procedures, regulatory and legal requirements and current health care standards.
Essentials:
<ol>
<li>Must be able to report to work fit for duty and free of any adverse effects of illegal drugs, medical marijuana, prescription medication, and/or alcohol. </li>
<li>Must be able to effectively communicate both orally and in writing with other individuals. </li>
<li>Must be able to work independently, anticipate and organize workflow, prioritize, and follow through on responsibilities. </li>
<li>Must be able to skillfully manage a high-volume caseload and to respond effectively to rapidly changing priorities</li>
</ol>

Physical Demands: Sitting, standing, walking, and lifting will occur for the majority of the shift. Must be able to lift 20 pounds. Must be able to sit/stand for extended periods of time. Fine motor skills. Visual acuity. Depth perception.

Clinical Documentation Specialist Nurse-Safety Sensitive

<h3>Job Description</h3>
We are recruiting for a motivated Clinical RN Documentation Specialist to join our team! We are here for life’s journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Clinical Document Integrity Job Summary Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director. Responsible for selected assignments based on internal or external department requests. Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary. Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record. Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies. Essential Functions 
<ul>
<li> Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of provider documentation. (20%) </li>
<li> Tracking audits performed and audit results obtained in order to provide meaningful data to key stakeholders. (20%) </li>
<li> Educating providers regarding documentation accuracy, specificity, and compliance with rules and regulations. (20%) </li>
<li> Providing pertinent feedback to providers on audit results as necessary. (20%) </li>
<li> Working collaboratively with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services, and other departments to promote the common goal of obtaining accurate documentation in the patient record. (20%) </li>
</ul>
Education 
<ul>
<li>Associate's Degree Required </li>
</ul>
Work Experience 
<ul>
<li>4-6 years Six years of experience as a nurse in a hospital environment Required and </li>
<li>4-6 years Three of the six years with the appropriate level of experience in one or a combination of the following medical documentation related function: clinical coding, case management, DRG coordination, physician education, Medicaid/Medicare reimbursement. Required </li>
</ul>
Licenses 
<ul>
<li>RN-Registered Nurse - DORA - Department of Regulatory Agencies Required </li>
</ul>
Knowledge, Skills And Abilities 
<ul>
<li>Must be able to demonstrate knowledge of the pathophysiology of the disease process.</li>
<li>Must be able to demonstrate clinical expertise in areas of urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care.</li>
<li>Must be able to communicate and interact tactfully with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively.</li>
<li>Ability to read and interpret professional journals, financial reports, and legal documents as necessary.</li>
<li>Ability to define problems collects and summarizes data, establish facts and draw conclusions.</li>
<li>Possesses knowledge of clinical documentation and coding concepts, DRG assignments, Inpatient Prospective Payment System (IPPS) and CMS rules and regulations.</li>
<li>Must also be able to demonstrate knowledge including but not limited to, value-based purchasing, bundled payments, accountable care organizations and readmission reduction program.</li>
<li>Microsoft Office Excel and SharePoint</li>
<li>Variety of documentation and coding programs. </li>
</ul>
Shift Days (United States of America) Work Type Regular Salary $77,300.00 - $119,800.00 / yr Benefits 
<ul>
<li>Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans</li>
<li>Free RTD EcoPass (public transportation)</li>
<li>On-site employee fitness center and wellness classes</li>
<li>Childcare discount programs &amp; exclusive perks on large brands, travel, and more</li>
<li>Tuition reimbursement &amp; assistance</li>
<li>Education &amp; development opportunities including career pathways and coaching</li>
<li>Professional clinical advancement program &amp; shared governance</li>
<li>Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program </li>
<li>National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer </li>
</ul>
Our Values 
<ul>
<li>Respect</li>
<li>Belonging</li>
<li>Accountability</li>
<li>Transparency </li>
</ul>
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison &amp; Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation. As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled.

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