Documentation Improvement Specialist (CDI) - HYBRID (4 days in Queens office)

NewYork-Presbyterian; United States; Hybrid; USD 101,000 - 151,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

NewYork-Presbyterian seeks a Documentation Improvement Specialist (CDI) to drive accurate medical record documentation. The hybrid role requires four in-office days in Queens and involves concurrent and retrospective interventions with physicians, residents and clinicians.

Responsibilities include providing education on regulatory documentation, identifying opportunities for improvement, and collaborating with the Coding Unit to ensure compliant, well-documented records across services.

Qualifications

• Bachelor's degree required.
• 5 years of hospital experience and/or verifiable CDI experience.
• Experience in an Electronic Medical Record (EMR) environment.
• Registered Nurse, Nurse Practitioner, OT, PT, PA or trained physician background.

Responsibilities

• Facilitate improvement of medical record documentation via concurrent and retrospective interventions.
• Provide education to physicians, residents and other licensed clinicians.
• Develop processes to identify opportunities and quantify deficits with records.
• Collaborate with Coding Unit and therapy staff on correct billing and documentation.

Skills

EMR experience

Documentation improvement

Interdisciplinary collaboration

Education

Bachelor's degree

Tools

EMR system

Job description

Location

New York, New York

Shift

Day (United States of America)

Description

Documentation Improvement Specialist (CDI) - HYBRID (4 days in Queens office)

The Documentation Improvement Specialist is responsible for facilitating improvement of medical record documentation by concurrent and retrospective interventions and interactions with, as well as the provision of education to physicians, residents, and other licensed independent practitioners. Develops process to identify opportunities for documentation improvement, intervene with attending physicians, residents, and physician extenders, in order to facilitate improvement in medical record documentation. Provides routine in-services to assigned clinical areas/Service Lines regarding regulatory documentation requirements including feedback on the impact of clinician documentation on Service Line metrics. Initiates and maintains records and databases to quantify the deficits, the interventions, and their impact. Conducts successful interventions related to documentation improvement and ensures follow through with all recommendations. Identifies, investigates, and evaluates practices and processes to facilitate continuous improvement in complete and accurate medical record documentation. Participates in retrospective medical record reviews to collect data and/or to resolve coding or documentation discrepancies. Maintains knowledge of coding, billing and documentation guidelines related to the therapists’ clinical professions and third party payer requirements. Collaborates with Manager of Coding Unit as needed. In collaboration with Coding Unit expertise, provides in-services to educate therapy staff and clinicians on the following but not limited to: correct billing, coding and documentation through clear verbal and/or written communication. Performs other job related duties as assigned.

Contract & Working Hours

This is full time day(8:00 am - 4:00 pm) position. You will be expected to be in office 4-5 days a week.

Required Criteria

• Bachelor's degree
• Registered Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician Assistant or trained Physician background
• 5 years of recent hospital experience and/or verifiable Documentation Improvement experience
• Experience in an Electronic Medical Record (EMR)environment

Preferred Criteria

• Registered Nurse with 2 years of CDI experience
• Bachelor’s Degree in Nursing
• Current Registered Nurse, Nurse Practitioner or Physician Assistant license highly preferred

Company Culture & Benefits

Join a healthcare system where employee engagement is at an all-time high. Here we foster a culture of respect, belonging, and inclusion. Enjoy comprehensive and competitive benefits that support you and your family in every aspect of life. Start your life-changing journey today.

Please note that all roles require on-site presence (variable by role). Therefore, all employees should live within a commutable distance to NYP. NYP will not reimburse for travel expenses.

Accolades

__________________ 2026 Best Companies in Healthcare, Biotech & Pharma – Glassdoor 2026 Best Place to Work – Glassdoor 2026 America’s Best Large Employers – Forbes 2026 America’s Best-In-State Employers – Forbes 2026 America’s Dream Employers – Forbes 2026 America’s Greatest Workplaces for Culture, Belonging & Community – Newsweek 2026 Best Places to Work in IT - Computerworld 2025 Great Place to Work Certified 2025 Best Employers for Women – Forbes 2025 Companies that Care – People 2025 America’s Greatest Workplaces for Mental Well-Being - Newsweek

Equal Opportunity Employer

NewYork-Presbyterian Hospital is an equal opportunity employer.

Salary

Salary Range: $101,000-$151,000/Annual

Compensation and Growth

It all begins with you. Our amazing compensation packages start with competitive base pay and include recognition for your experience, education, and licensure. Then we add our amazing benefits, countless opportunities for personal and professional growth and a dynamic environment that embraces every person. Join our team and discover where amazing works. Internationally acclaimed, our hospital leads the way in research, life‑shaping education and compassionate care. Step into a career at a truly Amazing place. Among the highest echelon of the topmost hospitals in the world, NewYork‑Presbyterian is Making It Possible for patients at this moment. What does this mean for you? Nothing less than an extraordinary career. We care for 1 out of every 4 New Yorkers in medical need. The nation's largest not‑for‑profit academic medical center, with over 2 million patient visits a year.