Senior Clinical Documentation & CDI Specialist

Memorial Hermann Health System; Houston (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

Memorial Hermann Health System seeks an RN with BSN/MSN and 5+ years of inpatient bedside experience to improve clinical documentation and coding accuracy. You will collaborate with physicians and the care team to ensure complete patient records and accurate DRG assignments.

Ideal candidates have ICU experience, strong communication, and a proactive approach to education and process improvement within an on-site hospital setting in Texas.

Qualifications

• Five (5) years of inpatient, acute care bedside experience.
• Excellent observation, analytical thinking, problem solving, and communication.
• Knowledge of many adult medicine areas.
• Ability to assess, evaluate, and teach.
• Strong organization and planning skills.
• Proficient with databases, spreadsheets, presentations, word processing, and Internet search.
• Willingness to adapt to change and learn.
• Self-motivated and able to work independently.
• Knowledge of payer regulations preferred.
• Team player with strong interpersonal skills.
• Professional and positive attitude.
• Heavy collaboration with hospital staff and physicians.

Responsibilities

• Communicate with physicians, case managers, coders to ensure complete documentation.
• Utilize CDI system to identify opportunities for improved documentation.
• Educate internal customers on compliance, coding, and documentation.
• Evaluate documentation daily for accuracy and completeness.
• Contribute to performance measures and physician data reporting.
• Coach physicians to reflect intensity of services and severity of illness.

Skills

RN

BSN/MSN

Acute care

ICU experience

Pediatric/Neonatal

Education

Bachelor of Nursing

Job description

Memorial Hermann Health System seeks an RN with BSN/MSN and 5+ years of inpatient bedside experience to improve clinical documentation and coding accuracy. You will collaborate with physicians and the care team to ensure complete patient records and accurate DRG assignments.

Ideal candidates have ICU experience, strong communication, and a proactive approach to education and process improvement within an on-site hospital setting in Texas.