Clinical Documentation Specialist

Job Summary

A company is looking for a Clinical Documentation Specialist.

Key Responsibilities

• Perform initial and follow-up reviews of inpatient records to identify clinical documentation improvement opportunities
• Utilize CDI software for accurate DRG, SOI, ROM, risk, and POA assignment
• Develop and conduct ongoing education programs for staff and clinicians on documentation practices

Required Qualifications

• An Associate's degree in health information technology or relevant certifications (RHIT, RHIA, RN, NP, PA, MD)
• Three years of experience in an inpatient setting in coding or clinical roles
• Adherence to the remote work agreement