Clinical Documentation Specialist
Summary
Audits clinical documentation and coding for compliance with ICD-10-CM, CPT, and HCPCS standards, delivers provider education, and ensures alignment with federal and Tribal health regulations.
The Clinical Documentation Specialist (CDS) performs documentation and coding audits, evaluates compliance, and delivers education across Kahtnuht’ana Development Corporation (KDC)’s clinical and operational teams. This role supports all awarded proposals, Indian Health Service (IHS) contracts, and Tribal health system requirements by ensuring documentation integrity, compliant coding practices, and alignment with federal, state, and Tribal regulations.
PRINCIPAL ACTIVITIES & RESPONSIBILITIES
- Establish and maintain a formal documentation and coding audit program.
- Conduct routine and targeted audits to validate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD 10 CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Procedure Coding System (PCS) code accuracy.
- Perform prospective and retrospective reviews to ensure medical necessity and documentation sufficiency.
- Analyze audit findings; prepare reports; deliver provider specific education.
- Develop follow up audits and documentation improvement plans.
- Provide coding guidance across inpatient, outpatient, professional, surgical, home health, and ancillary services.
- Design and deliver training programs for compliant coding and billing aligned with regulatory requirements.
- Evaluate vendor training materials for applicability across KDC operations and Tribal/IHS contract environments.
- Maintain current knowledge of federal/state regulatory changes; update training materials accordingly.
- Participate in committees, operational initiatives, and compliance reviews.
- Support documentation improvement efforts tied to grants, proposals, and contract deliverables.
- Ensure documentation practices align with Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), and Indian Health Service (IHS) requirements.
- Collaborate with Revenue Cycle and Quality teams to reduce denials related to documentation insufficiency and medical necessity.
- Assist in preparing documentation components for Prospective Payment System (PPS), All Inclusive Rate (AIR), and wrap around reimbursement submissions.
- Perform additional duties as assigned.
- Travel to customer site periodically as needed (up to 40%).