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 As a CDIS, you should: 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