Clinical Documentation Integrity Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Contribute positively to one of the leading health systems in the country.

• Assist in the effective delivery of award-winning patient care.

• Elevate your professional expertise to a higher level.

• Join a highly successful team focused on Clinical Documentation Integrity and Denial Management.

• Engage in daily reviews of high-acuity patient records to pinpoint potential and active payer denials.

• Evaluate clinical validity.

• Aid in denial prevention, analysis, and appeals across both inpatient and outpatient settings.

• Maintain continuous communication with department personnel.

• Provide education to physicians, residents, and mid-level providers.

• Support the implementation of appropriate documentation strategies.

• Collaborate with Medical Coding, Clinical Documentation Integrity, Case Management, and Quality teams.

• Collect and analyze information to ensure comprehensive medical record documentation.

• Guarantee the accuracy and completeness of clinical documentation to prevent denials.

• Prepare and submit high-quality appeal letters, backed by clinical evidence, regulatory guidelines, and payer-specific medical necessity criteria.

• Identify denial patterns and root causes, providing constructive feedback to the CDI and Clinical teams.

⛳️ Requirements

• Bachelor’s degree in a health-related field is preferred.

• A Registered Nurse (RN) license or MD diploma (or equivalent) is required.

• At least three years of experience in Clinical Documentation Integrity is required, preferably at an Academic Medical Center (AMC).

• Familiarity with coding guidelines and coding clinics is essential.

• Awareness of laws, rules, and regulations pertaining to proper clinical documentation for Medicare, Medi-Cal, CCS, etc. is necessary.

• Strong leadership, supervisory, and training capabilities are essential.

• Excellent critical thinking skills are required.

• Experience with EPIC and 3M 360 Encompass CAC is mandatory.

• Resourcefulness along with strong communication, organizational, and analytical skills is required.

• Ability to work collaboratively with physicians, staff, and interdisciplinary teams is essential.

• Proficiency in computer applications, including Word, Excel, and PowerPoint, is required.

• Skills in abstracting and interpreting medical information from patient records are required.

• Clinical experience sufficient to comprehend and communicate medical diagnoses and treatment plans to both professional and non-professional personnel is necessary.

• Proficient in computer word processing, database programs, and capable of writing reports and conducting graphical analysis is required.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and advancement.

• Supportive work environment with a focus on team collaboration.