Clinical Documentation Improvement (CDI) Specialist
InnovaCare Management Services Company, LLC Position Summary: Detail-oriented and data-savvy Clinical Documentation Improvement (CDI) Specialist. The ideal candidate will play a key role in ensuring accurate and complete clinical documentation that supports appropriate risk adjustment, ICD-10 coding integrity, and optimized reimbursement under Medicare Advantage and other value-based care programs. This role requires strong collaboration across departments and effective use of AI platforms and data tools to drive documentation excellence and compliance. Key Responsibilities: Review patient medical records (charts) for completeness, accuracy, and compliance with ICD-10-CM coding guidelines and CMS risk adjustment criteria. Identify documentation gaps or opportunities that impact HCC capture and risk scores Utilize AI-enabled CDI platforms, electronic health records (EHR), and data dashboards to analyze trends, prioritize chart reviews, and flag discrepancies. Work closely with primary care providers, specialists, and other clinical staff to clarify documentation and educate on best practices, when required. Collaborate with coding, billing, compliance, and analytics teams to align goals and implement CDI strategies, when required. Support the execution of cross-functional projects aimed at improving data integrity, documentation quality, and risk adjustment outcomes. Maintain accurate tracking and reporting of CDI queries, provider responses, and documentation improvements in designated systems or databases. Stay up to date on current CMS guidelines, ICD-10-CM updates, HCC risk adjustment models (CMS-HCC, RxHCC), and relevant healthcare regulations. Qualifications: Credentialed coder (CRC, CPC, CMPA or similar). Clinical background is a plus (RN, IMG). Minimum of 3 years of experience in clinical documentation improvement, risk adjustment, or outpatient medical coding. Strong understanding of ICD-10-CM coding, HCC coding principles, V28 risk model and Medicare Advantage documentation requirements. Experience working with AI-based CDI platforms, EHR systems, and healthcare data tools.
- Excellent communication, critical thinking, and problem-solving skills.
Ability to work independently and collaboratively in a fast-paced environment. Bilingual (English/Spanish) is a plus. Innovacare participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.