Clinical APNP Specialist - MCW Medical Group

Summary The Professional Billing CDI Clinical Specialist is an advanced practice provider role responsible for optimizing documentation practices within provider workflows. This role engages directly with providers to identify barriers, refine workflows, enhance EHR tools, and support adoption of efficient documentation practices. The Clinical Specialist also partners with CDI, coding, physician advisors, informatics, analytics, and revenue cycle leaders to ensure that documentation expectations remain clinically relevant, operationally practical, and aligned with coding and reimbursement requirements. Primary Responsibilities Independent Clinical Assessment of Documentation: Performs independent clinical evaluation of patient records to determine whether documentation accurately reflects diagnostic reasoning, treatment decisions, severity of illness, risk adjustment conditions, and medical necessity. Applies advanced practice clinical judgment to identify missed diagnoses, evolving conditions, treatment implications, and documentation gaps not readily identifiable through coding review alone. Serves as the clinical authority for complex documentation scenarios requiring provider-level interpretation of patient care. Provider-to-Provider Clinical Consultation: Provides peer-level consultation to physicians and APPs regarding clinical documentation, diagnostic specificity, medical necessity, and documentation supporting professional billing services. Facilitates provider-to-pr