Clinical Documentation Specialist - REMOTE

Jobgether

19h • Remote

About The Position

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Clinical Documentation Specialist - REMOTE. In this role, you will play a crucial part in ensuring accurate and comprehensive clinical documentation, which is essential for patient care and regulatory compliance. You will collaborate with healthcare professionals to enhance documentation quality and integrity, making a significant impact on patient outcomes and the overall effectiveness of care delivery. Your expertise will be vital in educating the care team on documentation guidelines and support continuous improvement initiatives.

Requirements

• Master's degree in Clinical, Healthcare or Business Administration preferred.
• 4+ years of recent clinical documentation experience required.
• 5+ years of acute care nursing experience in relevant settings required.
• Registered Nurse (RN), Certified Registered Nurse Practitioner (CRNP), Adult Acute Care Nurse Practitioner (ACNPC), Physician Assistant (PA), or ECFMG certification required.
• Certified Clinical Documentation Specialist (CCDS) required.

Responsibilities

• Conduct timely follow-up case reviews on concurrent cases, prioritizing clinical documentation clarifications.
• Participate in department meetings, providing feedback on outstanding issues and educational opportunities.
• Complete educational projects and present findings to the CDI team at least once yearly.
• Assist the CDI Manager with auditing CDS accounts and maintain CCDS credentialing.
• Maintain a high physician response rate to documentation queries and achieve compliance audit score targets.
• Educate team members on documentation regulations and quarterly Medicare updates.
• Collaborate with HIM staff to address discrepancies in DRG assignments.
• Review medical records for compliance, completeness, and accuracy.
• Accurately input data into CDI Software for metric reconciliation.
• Transcribe documentation clarifications for compliance purposes.

Benefits

• Comprehensive benefits from day one: Medical, Dental, Vision, Life Insurance, and Disability Insurance.
• Paid Time Off from day one.
• 403-B Retirement Plan.
• 4 weeks of 100% paid parental leave.
• Opportunities for career development.
• Resources for whole person well-being.
• Mental health resources and support.
• Pet benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level