Minnesota Licensed Clinical Documentation Specialist

Job Summary

To ensure accurate and compliant inpatient medical record documentation, the fully remote Minnesota Licensed Clinical Documentation Specialist will collaborate with healthcare teams to review patient records, identify documentation improvement opportunities, and enhance quality outcomes.

Key responsibilities

• Completes concurrent reviews of medical records for assigned patients and assigns accurate working DRGs
• Develops physician education strategies to promote complete and accurate clinical documentation
• Collects and analyzes data to demonstrate improvements in clinical documentation and DRG distribution

Required qualifications

• Associates Degree in Nursing or Health Information Management (HIM) or equivalent experience
• 2 years of acute/inpatient experience as an RN or 5 years of inpatient coding experience
• Knowledge of clinical documentation requirements related to regulatory and reimbursement rules
• Familiarity with ICD-10-CM and DRG classification systems
• Current registration as an RN, RHIA, or RHIT in Minnesota upon hire