Clinical Review Specialist

Job Summary

A company is looking for a Clinical Review Specialist to facilitate accurate patient medical condition identification through comprehensive chart reviews.

Key Responsibilities

• Perform pre-visit reviews of ambulatory encounters to identify and recapture medical conditions
• Educate providers on diagnostic specificity and improve medical record documentation
• Identify education and process improvement opportunities through chart reviews and collaborative communication

Required Qualifications

• 3-5 years of experience in case management, outpatient coding, utilization review, or CDI
• 2 years of experience in Primary Care, medical coding, risk adjustment, or CDI preferred
• Current certification in Clinical Documentation Improvement or medical coding preferred
• Medical licensure (RN, PA, NP) preferred
• Bachelor's degree in a healthcare-related field preferred