Clinical Documentation Specialist

Job Summary

A company is looking for a Clinical Documentation Specialist to join the Outpatient CDI team.

Key Responsibilities

• Conduct initial and follow-up reviews of medical records for assigned patients
• Identify and clarify incomplete or conflicting documentation in medical records
• Provide education to healthcare providers regarding accurate and complete clinical documentation

Required Qualifications, Training, and Education

• High School diploma or GED
• Five years of healthcare physician/facility related experience in auditing
• Completion of an approved coding or health information technology program
• Current certification(s) such as RHIA, RHIT, CCS, CCS-P or CPC, CPMA, CRC
• Clinical Documentation certification required within 2 years of hire