Clinical Review Specialist, Remote

Employer Industry: Healthcare Services

Why consider this job opportunity:

• Salary up to $90,750.40 annually
• Comprehensive benefits package, including career advancement opportunities and recognition programs
• Remote work flexibility
• Opportunity to educate providers and improve patient care quality
• Engage in process and quality improvement initiatives within a supportive team environment

• Conduct pre-visit reviews of selected ambulatory encounters to identify opportunities for recapturing medical conditions as HCC diagnoses
• Interpret clinical information in medical records to determine potential diagnoses
• Communicate HCC considerations to providers and educate them on diagnostic specificity
• Identify education opportunities and incorporate feedback from chart reviews
• Maintain professional competency through ongoing education and training

• Minimum three (3) to five (5) years of experience in case management, outpatient coding, utilization review, or clinical documentation improvement (CDI)
• Current certification in Clinical Documentation Improvement (CDIP, CCDS, CCDS‑O, or CDEO) preferred
• Certification in medical coding and/or risk adjustment (e.g., CRC, CPC, CCS, CDEO) preferred
• Medical licensure (RN, PA, NP) preferred
• Strong PC skills, including proficiency in Microsoft applications

• 2 years of experience in Primary Care, medical coding, risk adjustment, or CDI preferred
• Bachelor’s degree in a healthcare-related field preferred

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