CDI Specialist

Compass Memorial; Iowa; Presencial; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Compass Memorial Healthcare seeks a Clinical Documentation Integrity Specialist to review inpatient and outpatient records, ensuring accurate documentation of patient conditions and care. You will collaborate with physicians, nursing, coding, and revenue cycle teams to strengthen clinical narratives and support payer requirements.

The role emphasizes opportunities for provider education, documentation improvement, and reducing denials while maintaining regulatory compliance and high-quality

Formación

• Associate degree in Health Information Management or related healthcare field preferred; equivalent education and experience may be considered.
• 2+ years’ experience in clinical documentation, coding, HIM, nursing, or related healthcare discipline preferred.
• Knowledge of ICD-10-CM/PCS coding principles and clinical documentation requirements.
• Ability to work with physicians and healthcare staff collaboratively.
• Strong communication skills and attention to detail.

Responsabilidades

• Performs concurrent and retrospective review of medical records to identify documentation opportunities.
• Suggests chart corrections to ensure clinical condition and care are accurately reflected.
• Collaborates with clinical and coding teams to improve documentation and prevent denials.
• Reviews high-dollar or high-risk services to ensure medical necessity and payer requirements are supported.
• Provides clinical documentation support for prior authorizations and denial appeals as needed.
• Educates providers and staff on documentation requirements and best practices.

Conocimientos

Clinical documentation

Medical terminology

ICD-10-CM/PCS

Communication skills

Team collaboration

Reading comprehension

Educación

Associate degree in Health Information Management

Herramientas

Databases

Spreadsheet software

Word processing

Descripción del empleo

• Department: Health Information Management
• Position Type: Full Time
• Shift: Day

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs concurrent and retrospective review of inpatient, observation, emergency department, and targeted outpatient medical records to identify opportunities for accurate, complete, and clinically supported documentation.
• Identifies and facilitates appropriate chart corrections and documentation updates to ensure the medical record accurately reflects the patient’s clinical condition and care provided, consistent with organizational policies and applicable regulatory requirements.
• Identifies opportunities for clarification of diagnoses, severity, acuity, clinical indicators, medical necessity, and other elements of the patient’s clinical condition and initiates compliant provider queries when appropriate and supported by the medical record.
• Collaborates with physicians, advanced practice providers, nursing, coding, utilization review, Revenue Cycle, Central Scheduling, and other departments to improve clinical documentation and prevent documentation-related denials.
• Reviews outpatient documentation for high-risk or high-dollar services to determine whether the medical record supports the service, diagnosis, medical necessity, and applicable payer requirements, including imaging, infusions, injections, laboratory services, therapy, DME, procedures, and other targeted services.
• Performs targeted infusion and oncology documentation reviews to identify opportunities related to diagnosis specificity, drug indication, treatment plans, dosing and frequency, administration documentation, medical necessity, and payer requirements.
• Provides clinical documentation support for prior authorization by reviewing records when medical necessity or clinical criteria are not clearly supported and working with providers to clarify or strengthen documentation when appropriate.
• Conducts targeted pre-bill reviews of high-dollar or high-risk services and claims, using established service categories or dollar thresholds to identify documentation concerns before claims are submitted.
• Reviews emergency department documentation to identify opportunities related to diagnoses, medical decision-making, procedures, medical necessity, and documentation vulnerabilities that may contribute to payer downcoding or retrospective medical necessity denials.
• Conducts targeted clinic documentation reviews based on identified risk, denial trends, payer requirements, and service-specific concerns rather than reviewing all clinic encounters.
• Reviews recurring clinical and documentation-related denials and payer policies to determine whether the underlying issue involves documentation, coding, authorization, medical necessity, payer processing, or other factors.
• Works with the Revenue Cycle Manager to analyze documentation and coding trends, denial activity, audit findings, and payer requirements to identify opportunities for documentation improvement and denial prevention.
• Assists with and facilitates clinical portions of denial appeals by summarizing relevant medical record information, identifying clinical indicators supporting the diagnosis or service, and addressing the payer’s stated reason for denial.
• Provides education and feedback to providers and healthcare staff regarding documentation requirements, recurring deficiencies, payer expectations, and identified trends.
• Tracks recurring documentation deficiencies by provider, department, service line, and/or payer and provides focused education and feedback to address identified opportunities.
• Assists with identification and resolution of documentation concerns that may create compliance, audit, quality, medical-necessity, or reimbursement risk.
• Supports accurate representation of patient severity, complexity of care, quality measures, and applicable reimbursement requirements while maintaining compliance with clinical documentation and coding guidelines.
• Maintains current knowledge of applicable clinical documentation, coding, regulatory, clinical, and payer requirements and incorporates changes into CDI practices.
• Performs other duties and responsibilities as assigned within the scope of the position.

MINIMUM QUALIFICATIONS

• Associate degree in Health Information Management, Nursing, Health Sciences, or a related healthcare field preferred; equivalent education and relevant healthcare experience may be considered.
• Prefer two (2) or more years’ experience in clinical documentation, coding, health information management, nursing, or a related healthcare discipline.
• Prefer two (2) or more years’ experience with Clinical Documentation Integrity principles and compliant provider queries.
• Must have the ability to work with associated technologies relevant to the position.
• Knowledge of medical terminology, anatomy and physiology, pathophysiology, ICD-10-CM/PCS coding principles, and clinical documentation requirements.
• Ability to work with physicians in a collaborative manner.
• Ability to comprehend complex instructions.
• Ability to work within deadlines.
• Ability to write correspondence.
• Ability to effectively present information in one-on-one and in groups to providers, nursing staff and other employees within the organization for coding education.
• Ability to apply common sense understanding to carry out instructions furnished in written or oral form.
• Ability to communicate well with individuals over the phone or in person.
• Must be detailed oriented.
• Must possess the ability to effectively communicate, both verbally and in written form, information system problems, needs, and solutions with all levels of the organization.
• Must possess knowledge of databases, spreadsheet applications, and word processing.
• Must possess valid Mandatory Reporter training for Child and Dependent Adult Abuse.
• Must be able to read, speak, and write fluent English.

In order toprovide equal employment and advancement opportunities to all individuals, employment decisions at Compass Memorial Healthcare will be based on merit, qualifications, and abilities. Compass Memorial Healthcare does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, gender, national origin, age, physical or mental disability, sexual orientation, gender identity, or any other classification in accordance with federal, state and local statutes, regulations and ordinances.

Start your day with a delicious breakfast or enjoy a satisfying lunch at the May Street Café. You don’t have to be a patient to dine with us. Open to the community, dine in or grab your meal to go.

CMH Foundation

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