Inpatient CDS Trainee - Clinical Documentation Specialist

St. Francis Medical Center; Lynwood (CA); On-site; USD 36,000 - 40,000; Full time

Benefits offered by this job

Paid time off

401K

Medical coverage

Tuition reimbursement

Job summary

Prime Healthcare is seeking a CDS Trainee to conduct clinically based concurrent and retrospective reviews of inpatient medical records to ensure documentation accurately reflects quality of care and reimbursement. You will collaborate closely with physicians and staff to facilitate appropriate clinical documentation of patient care.

The role supports inpatient admission criteria reviews, initial and extended-stay concurrent reviews, and documentation of findings.

Qualifications

• Background in clinical documentation and inpatient reviews.
• Experience with acute care documentation and coding awareness is preferred.
• Strong communication and critical thinking skills.

Responsibilities

• Conduct clinically based concurrent and retrospective reviews of inpatient records to evaluate documentation reflects quality of care and reimbursement.
• Collaborate with medical staff to ensure appropriate clinical documentation of patient care.
• Document inpatient admission criteria and initial/extended-stay reviews for selected admissions.
• Perform additional duties as assigned.

Skills

Clinical documentation

Inpatient reviews

Collaboration with medical staff

Time management

Education

Graduate degree in Medicine/PA/Nursing

Job description

Prime Healthcare is seeking a CDS Trainee to conduct clinically based concurrent and retrospective reviews of inpatient medical records to ensure documentation accurately reflects quality of care and reimbursement. You will collaborate closely with physicians and staff to facilitate appropriate clinical documentation of patient care.

The role supports inpatient admission criteria reviews, initial and extended-stay concurrent reviews, and documentation of findings.