RN CDI Specialist: Elevate Documentation & Reimbursement

Santa Barbara Cottage Hospital; United States; Remote; USD 103,000 - 125,000; Full time

Job summary

R1 RCM Inc. is seeking a Clinical Documentation Improvement (CDI) Specialist to perform concurrent and retrospective reviews of inpatient records, ensuring accurate documentation, appropriate severity of illness, and quality of coding.

You will engage with physicians to obtain necessary documentation and support CDI initiatives. The role requires strong CDI knowledge, frontline hospital experience, and an active RN license with ICU/telemetry/ED exposure.

Qualifications

• CDI and medical record documentation knowledge required.
• Front line CDI experience in acute care hospital.
• RN license with ICU/telemetry/ED experience recommended.

Responsibilities

• Conduct concurrent and retrospective reviews of inpatient records to improve documentation quality.
• Identify opportunities to improve severity of illness and accuracy of coding.
• Educate providers on documentation requirements and coding guidelines.
• Collaborate with coders, auditors, and CDI team to resolve issues.
• Stay current with CMS rules and coding standards.

Skills

CDI practices

Medical record review

Clinical documentation

CMS regulations knowledge

RN license

Education

Associate’s degree in Nursing

Bachelor’s degree in Nursing preferred

Tools

EMR platforms

CDI platforms

Job description

R1 RCM Inc. is seeking a Clinical Documentation Improvement (CDI) Specialist to perform concurrent and retrospective reviews of inpatient records, ensuring accurate documentation, appropriate severity of illness, and quality of coding.

You will engage with physicians to obtain necessary documentation and support CDI initiatives. The role requires strong CDI knowledge, frontline hospital experience, and an active RN license with ICU/telemetry/ED exposure.