RN CDI Specialist: Elevate Documentation & Reimbursement

R1 RCM, Inc.; North Carolina; On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Annual bonus

Competitive benefits package

Job summary

R1 is seeking a Clinical Documentation Improvement (CDI) Specialist to perform concurrent and retrospective reviews of inpatient records, improve documentation quality, and support accurate severity of illness and resource utilization. You will work with physicians to obtain complete documentation and stay current with CMS rules, applying CDI practices across multiple patient care areas.

The role emphasizes collaboration with coders, auditors, and CDI leadership to drive high-quality coding,

Qualifications

• Front line CDI experience in an acute care hospital.
• Understanding of CDI practices and documentation requirements.
• Knowledge of CMS rules and regulations.

Responsibilities

• Initiates physician interaction to obtain documentation for accurate coding and compliance.
• Educates physicians and staff on documentation requirements and reimbursement policies.
• Applies coding guidelines to assign working DRGs and ensure high specificity.
• Collaborates with coders, auditors, and quality teams to resolve documentation issues.
• Stays updated on clinical documentation standards and regulatory changes.
• Performs mortality and PSI reviews and other identified CDI projects.

Skills

CDI experience

RN license

Clinical documentation

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Tools

EMR platforms

CDI platforms

Job description

R1 is seeking a Clinical Documentation Improvement (CDI) Specialist to perform concurrent and retrospective reviews of inpatient records, improve documentation quality, and support accurate severity of illness and resource utilization. You will work with physicians to obtain complete documentation and stay current with CMS rules, applying CDI practices across multiple patient care areas.

The role emphasizes collaboration with coders, auditors, and CDI leadership to drive high-quality coding,