Clinical Documentation Improvement Specialist

Pathways Health Partners

Pathways Health Partners is an Accountable Care Organization (ACO) on the forefront of helping independent providers make the transition to Value-Based Care.  Pathways operates a Medicare REACH ACO, a Medicare Advantage MSO, a Commercial MSO responsible for approximately 16,000 patients throughout North-West/Central Florida.  Our service area is The Villages, down to St. Petersburg, across to Mount Dora, and areas in between.  Pathways also operates a robust hospital medicine group, manages several of its affiliated medical practices, and an insurance agency.

Job Summary

The Clinical Documentation Improvement Specialist will review records, provide feedback, and train providers, their staff, and others on proper documentation of medical encounters and to ensure the level of care and clinical risk is communicated to the insurance carriers through proper procedural and diagnosis coding. 

Role and Responsibilities

• Analyzes medical records and identifies documentation deficiencies.
• Reviews and verifies documentation supporting diagnoses, procedures, and treatment results.
• Recommends codes for research and compliance with regulatory requirements utilizing coding clinic guidelines.
• Identifies discrepancies, potential quality of care, and billing issues.
• Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors.
• Serves as resource and subject matter expert to other coding staff, providers, and other key stakeholders.
• Assists lead or supervisor in orienting training, and mentoring staff.
• Provides ongoing training to staff and providers as needed.
• Handles special projects as requested/assigned.

Qualifications and Education Requirements

• High School Diploma, or equivalent
• Associates Degree or Certificate in Procedural and/or Risk Coding, or equivalent
• An Active Certified Risk Adjustment Coder (CRC) or 
• Certified Professional Coder (CPC) designation

Preferred Skills

• High School Diploma or GED
• One year experience in a healthcare setting
• Organization and time management skills
• Administrative writing/typing skills
• Willingness to continually self-educate

Why Work for Pathways?

Pathways Health Partners is a growing company based in Leesburg, FL.  We are proud of our professional yet family culture with the executive team working daily alongside our team members.  We provide competitive salaries, bonuses for all team members, and a benefits package that is second to none.  

• Medical Insurance for Employee and Spouse/Significant Other paid 100% by Pathways!
• Addition of family coverage for dependents at a fraction of the cost
• 25K life insurance for Employee 100% paid by Pathways!
• Increasing Employee coverage or adding spouse/dependents at a fraction of the cost
• Vision and Dental Coverage available at a very low cost for employee, spouse, and family
• Short-Term and Long-Term Disability for Employee 100% paid by Pathways!
• 401K retirement plan with 100% match up to 4% of annual pay
• Paid holidays
• Ample Paid Time Off (PTO) for vacation/sick/personal days

We look forward to speaking with you about this opportunity!