California Licensed Documentation Specialist

Job Summary

Working remotely in a full-time capacity, the California Licensed Documentation Specialist will review medical records to ensure documentation accuracy, assign medical codes, and enhance clinical documentation integrity while supporting regulatory compliance and conducting staff training.

Key responsibilities:

• Review and rectify medical records to promote accuracy and completeness of clinical documentation
• Integrate processes to improve clinical documentation and support documentation issue resolution
• Conduct staff training and education on clinical documentation improvement and coding standards

Required qualifications:

• Minimum two years of experience in an inpatient acute care or clinical setting
• Bachelor's degree in Nursing, Medicine, Health Administration, Health Information Management, or related field, with additional relevant experience
• California Physician Assistant License, Doctor of Medicine License, Nurse Practitioner Certificate, or Registered Nurse License required at hire