Clinical Documentation Improvement Specialist

Job Summary

A company is looking for a Clinical Documentation Improvement Specialist.

Key Responsibilities

• Communicate with the healthcare team to clarify and obtain necessary medical record documentation
• Conduct in-depth chart reviews to ensure accurate documentation supporting severity of illness and complexity of care
• Collaborate with healthcare professionals to enhance quality metrics through improved documentation practices

Required Qualifications, Training, and Education

• Minimum of two years' acute care hospital experience
• Experience in critical care, general medical, and/or surgical nursing is beneficial
• Previous experience with criteria-based chart reviews such as case management or quality improvement
• Clinical documentation improvement experience with knowledge of ICD code assignment and DRG assignment preferred
• Completion of extensive training modules and one-on-one sessions with a CDI trainer