Professional/Ambulatory Clinical Documentation Improvement Specialist

Caring For the Community You Love

Choose a career to make a difference in people's lives every day, choose Fisher-Titus!

Perks of working at Fisher-Titus:

• Hours of Work-Full time
• Comprehensive Benefits Package- Medical & Dental coverage, 401K match, paid time off, tuition assistance and more!
• Shift, Weekend & PRN differential

About Fisher-Titus:

Fisher-Titus proudly serves the greater Huron County area’s 70,000-plus residents by providing a full continuum of health and wellness care from heart and cancer care to outpatient services such as lab, imaging, and physical rehabilitation.

Vision: Be the first choice for healthcare and employment within our community

Mission: Deliver compassionate and convenient care to the highest level of excellence that promotes lifelong health and wellness for our community

General Summary:

The Ambulatory/Professional Fee Clinical Documentation Specialist (CDS) serves as an advisor and expert resource to providers, supporting accurate and complete clinical documentation that reflects patient complexity, risk profiles, and appropriate Evaluation and Management (E/M) service levels. This role supports professional fee billing accuracy, appropriate reimbursement, and compliance with applicable regulatory and industry standards.

The Professional Fee CDS identifies clinically relevant information and documentation opportunities through comprehensive chart review. The role focuses on the recapture and identification of chronic conditions represented by Hierarchical Condition Categories (HCCs), which contribute to a patient’s risk-adjusted profile and Risk Adjustment Factor (RAF) score. The CDS also evaluates documentation and medical decision making to identify opportunities to appropriately reflect the level of service provided.

The Professional Fee CDS performs pre-visit and post-claim reviews and provides clear, actionable education and feedback to providers regarding clinical documentation, diagnosis coding, E/M level assignment, and billing practices. The CDS collaborates with Professional Fee CDI leadership, clinical documentation colleagues, coding teams, and other organizational partners to improve documentation practices and support compliant patient care and reimbursement.

Review Responsibilities May Include:

• Pre-visit reviews: Identify opportunities to recapture previously documented HCC conditions and identify potential new or “suspect” conditions supported by appropriate clinical indicators and the patient’s medical record. These reviews support accurate patient risk profiles and associated healthcare resource utilization.
• Post-claim reviews: Evaluate E/M encounters to identify opportunities related to medical decision-making, patient acuity, E/M level assignment, diagnosis capture, and HCC documentation.
• Provider education: Deliver individualized and group education to providers based on findings from pre-visit and post-claim reviews, data analytics, provider performance trends, and identified documentation or coding opportunities.

Typical Responsibilities

• Collaborates with Professional Fee CDI leadership, CDI and coding teams, and other organizational partners to support program objectives, coordinate initiatives, and foster effective teamwork.
• Uses performance, outcome, and other available data to identify high-priority providers, specialties, encounter types, workflow opportunities, and educational needs.
• Supports the development, implementation, and evaluation of Professional Fee CDI workflows, processes, education schedules, and program initiatives.
• Identifies opportunities to clarify the medical record in a compliant and non-leading manner, consistent with applicable coding, documentation, query, regulatory, and organizational guidelines.
• Creates and delivers specialty-specific education and ongoing feedback based on chart review findings, data analytics, provider performance trends, and identified documentation or coding opportunities.
• Communicates effectively with providers, CDI team members, coding, compliance, and other stakeholders through individual consultations, provider meetings, department or specialty sessions, and other appropriate forums.
• Maintains current knowledge of CMS requirements, official coding guidelines, HCC models, risk adjustment principles, E/M guidelines, clinical documentation requirements, and applicable industry standards.
• Maintains confidentiality in accordance with HIPAA and applicable privacy and security requirements; follows organizational policies and procedures; demonstrates professionalism and respect in all interactions; and pursues ongoing professional growth and development.

Knowledge, Skills, and Experience

• Extensive clinical knowledge and understanding of anatomy, physiology, pathophysiology, and disease processes.
• Knowledge of professional fee coding, E/M guidelines, HCCs, risk adjustment, RAF methodology, and clinical documentation principles.
• Strong critical-thinking skills and the ability to apply clinical knowledge to identify potential clinical indicators that support patient acuity and medical record clarification.
• Excellent written, verbal, interpersonal, and presentation skills.
• Strong project management, organizational, and time-management skills.
• Demonstrated ability to communicate effectively with providers and individuals at all levels of the organization.
• Ability to work independently and manage multiple priorities in a time-sensitive environment.
• Demonstrated proficiency and comfort working in electronic medical records; Epic experience preferred.
• Proficiency with Microsoft Office applications, including Excel, Word, and PowerPoint.
• Ability to develop clear, relevant, and meaningful educational materials for providers and team members.
• Strong problem-solving, analytical, investigative, and decision-making skills.
• Ability to interpret performance and outcome data and use findings to prioritize provider education and review activities.
• Commitment to compliant, accurate, objective, and non-leading clinical documentation practices.

Education and Credentials

• Registered Nurse (RN) or Licensed Practical Nurse (LPN) experience preferred but not required.
• Associate degree preferred; high school diploma or equivalent required.
• At least two years of professional fee coding, clinical documentation, risk adjustment, or related healthcare experience.
• CCS-P, CPC, CRC, or other relevant coding or clinical documentation credential required or preferred based on organizational requirements.
• This is a hybrid position which sometimes requires the ability to work in person and offers flexibility to work from home

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Standards of Employment:

Attends all mandatory education programs and can describe his or her responsibilities related to general safety and regulatory compliance.

Appearance is professional, neat, clean, and appropriate for the work environment. Wears proper photo identification badge while on duty.

Maintains confidentiality of all hospital and patient information at all times, as observed by peers and management.

Attends monthly staff meetings and participates in monthly rounding process with manager to assure effective and timely two-way communications.

Participates in and completes required department specific education and training programs and can describe his or her responsibilities related to department safety and specific job-related hazards.

Follows safety and security policies including exposure control plans/blood borne and airborne pathogens.

Core Requirements:

Supports the mission, vision and CARES values of Fisher Titus.

Is knowledgeable of patient rights and ensures an atmosphere which allows for the privacy, dignity and well-being of all patients in a safe, secure environment.

Supports, cooperates with, and implements specific procedures and programs for:

• Safety, including universal precautions and safe work practices, established fire/safety/disaster plans, risk management, and security, report and/or correct unsafe working conditions, equipment repair and maintenance needs.
• Confidentiality of all data, including patient, employee and operations data.
• Quality Assurance and compliance with all regulatory requirements.
• Compliance with current law and policy to provide a work environment free from sexual harassment and all illegal and discriminatory behavior.

Key Service Behavior:

Communicates with Compassion - Every patient, Every time

• Engages in active listening skills
• Utilizes the AIDET communication tool
• Uses key words at key times
• Utilizes HEART service recovery techniques

Demonstrates Service Etiquette - Every patient, Every time

• Smiles and greets patients using the 10/5 rule
• Demonstrates a calm, positive attitude through tone and body language
• Ensures patient privacy and promotes a healing environment
• Adjusts approach to respect the diversity of patients
• Assesses and manages patient's expectations of care

Commitment to Safety - Every patient, Every time

• Follows established safety guidelines to reduce risk of adverse event through early recognition
• Commits to the Culture of Safety; If you see something, say something

Delivering High Quality Care - Every patient, Every time

• Commits to efficient, effective and purposeful work and delivery of care
• Engages in practices that will continually improve processes