Clinical Documentation Quality Specialist

Texoma Medical Center; Edinburg (TX); On-site; USD 75,000 - 110,000; Full time

Job summary

UHS is seeking a Clinical Documentation Improvement Specialist to enhance the quality and completeness of clinical documentation. The role partners with concurrent clinical reviewers, medical record coders, and physicians to improve reimbursement by ensuring precise, evidence-based documentation reflecting illness severity and intensity of care.

The position requires strong communication, critical thinking, and the ability to work independently in a fast-paced environment, with travel between

Qualifications

• Excellent written and verbal communication skills required.
• Excellent critical thinking skills required and must be detail oriented.
• Knowledge of age-specific needs and elements of disease process and related procedures required. Strong broad based clinical knowledge and understanding of pathology/physiology of disease processes.
• Ability to work independently in a time-oriented environment is essential.
• Working knowledge of Medicare reimbursement system and coding structures preferred, by not required.
• Computer literacy essential.
• Must demonstrate commitment and adherence to STHS’s Compliance Program and Code of Conduct through compliance with all policies and procedures, the Code of Conduct, attendance at required training and immediately reporting suspected compliance issue(s) to the Compliance Officer.

Responsibilities

• Improve the overall quality and completeness of clinical documentation by coordinating with reviewers, coders, and physicians to enhance reimbursement and accuracy of patient data.

Skills

Written and verbal communication

Critical thinking

Detail oriented

Clinical knowledge

Independent work

Medicare reimbursement knowledge

Computer literacy

Compliance awareness

Education

Nursing or healthcare-related degree

Advanced degree acceptable (International MD)

Job description

UHS is seeking a Clinical Documentation Improvement Specialist to enhance the quality and completeness of clinical documentation. The role partners with concurrent clinical reviewers, medical record coders, and physicians to improve reimbursement by ensuring precise, evidence-based documentation reflecting illness severity and intensity of care.

The position requires strong communication, critical thinking, and the ability to work independently in a fast-paced environment, with travel between