WHO YOU ARE
You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Does this sound like you? If so, we should talk.
WHO WE ARE
Evergreen Nephrology partners with nephrologists to transform kidney care through a value- based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.
We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.
We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
Your Role
As a Clinical Documentation Improvement Partner, you will partner with physician practices within our established partnerships to facilitate documentation improvement strategies and regulatory compliance. You will assist them in translating healthcare documentation into standardized codes, ensuring accurate coding and billing of patient encounters, as supported by the medical record. You serve as a subject matter expert in coding and documentation improvement and do not shy away from hard discussions with providers. You advise and educate physicians and other professional clinical staff on coding and documentation best practices and regulatory compliance and thrive in a fast-paced environment with minimal oversight, making important decisions for both Evergreen and our partners.
Primary Functions
- Review physician practice partners’ diagnosis codes for accuracy based on documented information, ensuring compliance with regulatory requirements and that the assigned codes accurately represent the clinical information documented by the provider.
- Ensure that documentation supports appropriate level(s) of care and severity of illness when applying ICD-10, CPT, and other relevant codes for billing and regulatory
- Maintain a 95% productivity rate
- Engage and partner with physicians and other healthcare providers to clarify documentation and confirm that diagnoses and procedures are properly documented in compliance with applicable clinical standards, while also advising on improvement
- Determine when provider claims must be withheld or withdrawn and professionally engaging with partner practices to align on improvement efforts and compliance
- Stay updated on current coding guidelines, clinical protocols, and regulatory changes, including Medicare and Medicaid guidelines on billing and coding, to support provider compliance therewith.
- Assist in improving the quality of clinical documentation enterprise-wide and with our physician practice partners to support various quality initiatives, such as HEDIS, CMS, and other contractual or enterprise-initiated performance metrics.
- Create and implement performance improvement projects aimed at improving documentation practices and outcomes.
- Audit medical records to identify trends in documentation, both positive and negative, to improve documentation practices and provider education efforts.
- Develop and provide ongoing education to clinical staff, coders, and other healthcare providers on best practices in clinical documentation, coding guidelines, and regulatory
- Develop individualized training programs to address documentation deficiencies and improve overall documentation quality.
- Collaborate with other departments such as compliance, revenue cycle, and quality management to optimize the documentation improvement process.
- Other duties as reasonably
How You Qualify
- Strong knowledge of ICD-10-CM, Category II and CPT
- Proficiency in medical terminology, anatomy, and physiology.
- Familiarity with healthcare laws, regulations, and other applicable guidance, such as Medicare, Medicaid, HEDIS, and CMS performance measures.
- Knowledge of risk adjustment methodology and Hierarchical Condition Categories (HCC).
- Ability to analyze complex medical records, identify documentation gaps, and determine appropriate queries.
- Strong written and verbal communication
- Meticulous attention to detail that ensures a high level of accuracy in your work
- Ability to identify discrepancies in clinical documentation and partner with providers to resolve issues efficiently
- Familiarity with electronic health records (EHR), CDI software, and healthcare documentation systems is essential
- High school diploma, GED, or suitable equivalent
- 2+ years recent outpatient medical coding experience
- Must possess one of the following coding credentials: CPC, CRC, CCS, or similar
- Intermediate skills with MS Office Suite of products including Outlook and Teams
- You have the ability to work effectively in a primarily remote environment:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wired to the house internet (Cable, Fiber, or DSL) and hardwired to the internet device is recommended
- Evergreen will provide Remote or Hybrid Home/Office employees with telephony applications and equipment to meet the business requirements for their position/job
- Team Members must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred:
- Associate’s or Bachelor ‘s Degree in nursing (BSN/ASN), health information management (HIM) or related healthcare field
- HCC coding experience
Pay range for this role is $60,000 to $73,000, with exact pay determined based on experience, education, demand for role, geographic location and other role-specific criteria.
HOW YOU’RE SUPPORTED
- You will benefit from Evergreen Nephrology’s exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at four weeks for full-time employees, 12 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance, and paid parental leave
- We commit to a robust training and development program that starts with onboarding and continues throughout your career with Evergreen Nephrology
- As an inclusive and diverse team, you will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Evergreen Nephrology’s high-quality, value-based care model
Evergreen Nephrology is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.
Evergreen Nephrology will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants.
Evergreen Nephrology is committed to working with and providing reasonable accommodations to job applicants with physical or mental disabilities. Applicants with a disability who require a reasonable accommodation for any part of the application or hiring process should email us for assistance. Reasonable accommodations will be determined on a case-by-case basis.
Common characteristics of the people who comprise Evergreen Nephrology:
Smart, detail-oriented, purpose-driven, tenacious, and operates with urgency
