Lead, Clinical Documentation Improvement Specialist

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

📋 Description

• Provide leadership in both clinical and operational aspects for the Clinical Documentation Improvement program.

• Oversee and sustain the CDI Quality Assurance program, which includes conducting audits, monitoring quality, gathering staff feedback, analyzing trends, and identifying areas for improvement.

• Stay informed on CMS guidelines, ICD-10-CM coding standards, risk adjustment methodologies, HCC models, and payer specifications.

• Relay regulatory and industry updates to the CDI team.

• Create and implement CDI educational programs and training sessions.

• Spearhead educational initiatives for providers and health centers, developing presentations, training materials, job aids, and documentation resources.

• Perform prospective medical record audits to uncover documentation, coding, clinical specificity, and risk adjustment opportunities.

• Analyze audit results and trends, formulating actionable recommendations.

• Enhance CDI workflows, processes, tools, and operational standards.

• Act as a subject matter expert in CDI for staff, providers, and health center stakeholders.

• Assist in the expansion of the CDI program across new health centers, providers, patient demographics, and value-based care contracts.

• Collaborate with clinical, operational, and technical teams to drive improvements in outcomes.

⛳️ Requirements

• A current professional certification is required (CCS, CPC, CRC, RHIT, RHIA, or equivalent).

• A minimum of five (5) years of experience in Clinical Documentation Improvement, coding audits, risk adjustment, quality assurance, or related healthcare operations.

• Advanced understanding of ICD-10-CM coding standards, risk adjustment methodologies, HCC models, and relevant regulatory requirements.

• Experience in conducting documentation reviews, prospective audits, and quality assurance activities.

• Strong analytical, critical thinking, and process improvement capabilities.

• Exceptional written, verbal, presentation, and stakeholder engagement skills.

• Capability to manage multiple priorities while collaborating effectively with cross-functional teams.

• Candidates must reside and work in an approved state at the time of hire and throughout their employment.

• Health Choice Network cannot employ individuals who live or work in California.

🏝️ Benefits

• 100% Remote Work – Work from anywhere in the U.S.

• 100% Employer-Paid Medical Insurance on one of our health plans.

• Annual $1,500 HSA Contribution.

• Generous Paid Time Off (PTO).

• 403(b) Retirement Plan with Employer Contribution.

• Professional Development & Education Assistance.

• Mission-Driven Culture Focused on Community Health.