RN CDI Specialist: Elevate Documentation & Reimbursement

McLaren Health Care; Lansing (MI); On-site; USD 70,000 - 90,000; Full time

Job summary

McLaren Health Care in Michigan is seeking a Clinical Documentation Improvement (CDI) Specialist to enhance the quality and completeness of medical record documentation. The role focuses on capturing accurate, complete, and compliant documentation to support outcomes and revenue integrity through collaboration with clinicians and coding staff.

Responsibilities include daily chart reviews to identify documentation gaps, performing queries, educating care teams on guidelines and

Qualifications

• Current RN license in the state of practice.
• Minimum 5 years of acute hospital care experience.
• CDIP certification preferred.
• Inpatient coding experience preferred.

Responsibilities

• Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes.
• Performs daily chart reviews seeking opportunity to clarify (query) documentation to capture accurate, complete and compliant documentation.
• Educates all members of the patient care team regarding clinical documentation needs, changes to guidelines, coding and reimbursement issues, and pay for performance documentation requirements.
• Uses interpersonal skills to discuss clinical documentation issues and work with coders, physicians, nursing staff, and other professionals to resolve issues.
• Facilitates the Documentation Improvement Initiative and directs others toward objectives that contribute to program success.
• Articulates the program to physician and other health care professionals to educate and teach documentation requirements for MS-DRG reimbursement and quality measures.
• Performs other related duties as required and directed.

Skills

Clinical documentation

Interpersonal communication

Medical record review

Query writing

Education

Registered Nurse (RN) license

Tools

3M 360

JATA

ChartWise

Job description

McLaren Health Care in Michigan is seeking a Clinical Documentation Improvement (CDI) Specialist to enhance the quality and completeness of medical record documentation. The role focuses on capturing accurate, complete, and compliant documentation to support outcomes and revenue integrity through collaboration with clinicians and coding staff.

Responsibilities include daily chart reviews to identify documentation gaps, performing queries, educating care teams on guidelines and