Clinical Documentation Improvement Specialist - Full Time

Job description

DESCRIPTION OF POSITION: SUPERVISION : Reports directly to the Director of CDI - The Clinical Documentation Improvement Specialist facilitates the improvement of the overall quality, completeness and accuracy of medical record documentation. To obtain and promote appropriate clinical documentation through extensive interaction with physicians and other members of the patient care team and coding staff. To ensure Clinical Documentation reflects the level of service, severity of illness and is complete and accurate. RESPONSIBILITIES AND DUTIES: The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description. - Concurrently reviews inpatient admissions to identify opportunities to improve the quality of documentation. - Complies with all relevant policies, procedures, guidelines and other regulatory, compliance and accreditation standards. - Initiates physician interaction to clarify ambiguous or conflicting documentation and assure any clarification is noted in the patient record according to policy....