Clinical Documentation Specialist - Nursing

Avita Health System; Crestline (OH); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Competitive wages

PTO

Health insurance

Dental insurance

Vision insurance

403(b) plan

Parental leave

Pharmacy discounts

Free parking

Career growth

DAISY Award recognition

Job summary

Avita Health System in Ohio's Ontario location seeks a Clinical Documentation Specialist to improve the quality and completeness of provider-based documentation in the medical record.

You will collaborate with treating providers to ensure documentation reflects illness severity and services rendered, review records for accurate reimbursement, and report results to the Manager and Director.

Qualifications

• Current RN Nursing License in the State of Ohio.
• ICD10, CPT and HCPCS coding knowledge.
• Knowledge of medical terminology, anatomy and physiology.
• Two years of CDI experience in a hospital setting (preferred).
• CDI certification from AHIMA- or ACDIS-approved program (preferred).

Responsibilities

• Accountable for improving quality and completeness of provider-based clinical documentation.
• Collaborates with treating providers to reflect illness severity and services rendered.
• Reviews records to ensure documentation supports appropriate reimbursement.
• Monitors program results and reports to Manager and Director.

Skills

Nursing license

Coding knowledge

Medical terminology

Job description

Avita Health System is proud to serve the communities of Crawford and Richland counties through three hospitals and numerous clinic locations. Over the past few years, we’ve tripled in size, now employing over 2,300 team members and more than 200 physicians and advanced practitioners. Our mission is to deliver high-quality, compassionate care to the people who depend on us.

We’re currently seeking a dedicated Clinical Documentation Specialist to join our Medical Records Department at our Ontario location.

Position Overview

Accountable for facilitating improvement in overall quality and completeness of provider-based clinical documentation in the medical record. Works collaboratively with treating providers to ensure documentation in the medical record accurately reflects severity of illness as well as level of services rendered. Assesses documentation through extensive review of the record and interacts with physicians, case managers, and HIM coding staff to ensure appropriate reimbursement is received and clinical information utilized in profiling and reporting outcomes is accurate. Monitors program results and reports to Manager and Director.

Qualifications

Required

• Current RN Nursing License in the State of Ohio
• ICD10, CPT AND HCPCS coding knowledge.
• Knowledge of medical terminology, anatomy and physiology.

Preferred Qualifications

• Two years of experience as a CDI specialist in a hospital setting.
• CDI certification from an AHIMA- or ACDIS-approved program.

Why Join the Avita Health System Team?

At Avita, we’re committed to creating a supportive, inclusive, and empowering environment where every team member plays a vital role in delivering exceptional care to our communities. Whether you're on the front lines or behind the scenes, your work matters here.

What You Can Expect at Avita:

• A collaborative and engaged workplace culture
• Competitive wages and comprehensive benefits
• Generous paid time off (PTO) to support work-life balance
• Health, dental, and vision insurance options
• 403(b) retirement plans with up to 4% employer match
• Paid parental leave
• Pharmacy discounts for employees
• Free on-site parking
• Opportunities for professional growth and internal advancement
• Recognition programs, including the DAISY Nursing Award for excellence

Join a team that values your contributions and supports your career journey every step of the way.

Avita Health System is an Equal Opportunity Employer.