Clinical Documentation Integrity Specialist (contract; 20-25 hours/week)

firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians, which focuses on meeting each individual where they are and walking with them side by side as a trusted guide, partner, and first call on their journey to wellness.

firsthand's team members use their lived experience to build trust with these individuals and support them in obtaining socio-economic assistance and in reconnecting to primary and behavioral care. Support like this creates substantial savings for managed care organizations (Medicaid providers) and taxpayers by decreasing inappropriate healthcare utilization. This enables us to build solutions that scale and, as a result, change the way our society supports those most impacted by SMI.

We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job—it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun.

The Clinical Documentation Integrity Specialist (CDIS) is a key member of firsthand’s clinical documentation team. We are looking for a scrappy, detail-obsessed individual who will ensure accurate, comprehensive, and timely clinical documentation. The CDIS will enable the best care possible for our individuals by empowering: our care teams to plan appropriate care, our support teams to identify potential population health interventions, and more. This is a part-time, remote contract position. The expected workload is 20-25 hours per week, with flexible scheduling available between 9 AM and 5 PM in the Eastern, Central, and Mountain time zones.

• Perform prospective, retrospective, and concurrent coding reviews based on evaluations of prior visit documentation, lab results, images, external medical records, payer claims data, and more
• Demonstrate an understanding of complications, comorbidities, case mix and the impact of procedures on the billed record as well as the ability to impart this knowledge to providers and other members of the healthcare team.
• Support pre-visit planning by communicating to firsthand providers individuals’ potential chronic conditions and care gaps with robust and appropriate evidence
• Ensure accurate, timely, and comprehensive clinical documentation to support code capture, including querying providers when these clinical documentation standards are not met
• Support medical records requests when providers require additional information prior to addressing and diagnosing potential conditions
• Work with team leadership to identify chronic condition prevalence trends by individuals’ demographics; identify and execute potential interventions, e.g., ongoing education to firsthand providers and the CDI team, ongoing quarterly retrospective reviews of unaddressed suspects

• Certified Risk Adjustment Coder (CRC) from AAPC in good standing
• An Associate’s or Bachelor’s degree in a healthcare related field with RHIA, RHIT, CRC or CCS credential, RN or LPN license is required
• Minimum of 5 years of risk adjustment-focused medical record review and ICD-10 coding experience, specifically using the Medicare HCC model, in multiple settings (e.g., inpatient, outpatient) Fluent knowledge of ICD-10 CM Official Guidelines for Coding and Reporting, and AHA/AMA/CMS coding resources, to support audit findings
• Ability to gain proficiency in and apply productivity tools, such as spreadsheets, Google Suite, and EHR systems
• Excellent written and verbal communication skills, especially to maintain working relationships with firsthand providers (APNs, NPs), other CDISs, Medical Records Specialists, and others
• Proven experience working remotely
• Alignment to firsthand’s mission, vision and values: Demonstrate respect, dignity, empathy, and professional conduct to both individuals that firsthand serves and firsthand team members

• Demonstrate mastery of the Medicare HCC model, clinical coding guidelines/methodologies, and AHIMA/ACDIS ethical standards of coding; self-motivated to stay abreast of CMS rules and incorporate those changes into daily work
• Proficiency in tracking down, leveraging, and reviewing high volumes of internal and external data (e.g., medical records) to support pre-visit planning and appropriate code capture
• Self-starter with a high degree of drive, initiative, and follow through; comfortable and motivated to work in a fast-paced, ever-changing environment with a passion for problem solving
• Exceptional interpersonal, written and verbal communication skills; proven ability to collaborate across multiple teams and engage in multiple perspectives to work toward a common goal
• Query providers in an ethical manner and track compliance
• Develop CDI polices and procedures to include query process, education and training, and performance tracking
• Bonus but not necessary: familiarity with Medicaid risk models, such as CDPS or ACG

Benefits 

For full-time employees, our compensation package includes base, equity (or special incentive program for clinical roles) and performance bonus potential. Our benefits include physical and mental health, dental, vision, 401(k) with a match, 16 weeks parental leave for either parent, flexible vacation, and a supportive and inclusive culture.

Vaccination Policy

Employment with firsthand is contingent upon attesting to medical clearance requirements, which include, but may not be limited to: evidence of vaccination for/immunity to COVID-19, Hepatitis B, Influenza, MMR, Chickenpox, Tetanus and Diphtheria. All employees of firsthand are required to receive these vaccinations on a cadence/frequency as advised by the CDC, whereas not otherwise prohibited by state law.

New hires may submit for consideration a request to be exempted from these requirements (based on a valid religious or medical reason) via forms provided by firsthand. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed.

Unfortunately, we are not able to offer sponsorship at this time.