Clinical Documentation Integrity Specialist

About This Role

This role focuses on strengthening documentation accuracy, supporting denial prevention, and improving the integrity of clinical records across a complex healthcare environment. The specialist will collaborate closely with clinical teams, coding stakeholders, and other departments to ensure records are complete, compliant, and well-supported. This position also plays a key role in identifying denial trends, preparing evidence-based appeals, and promoting continuous improvement in documentation practices.

Responsibilities

• Review high-acuity patient records daily to identify payer denials
• Assess clinical validity and support denial prevention and appeals
• Communicate continuously with department staff and educate clinical personnel
• Partner with multiple departments to analyze and gather information
• Prepare and submit quality appeal letters based on clinical evidence
• Identify denial trends and root causes, providing feedback
• Ensure accuracy and completeness of clinical documentation

Requirements

• Bachelor's degree in a health-related field preferred
• Registered Nurse (RN) license or MD diploma required
• Minimum three years of Clinical Documentation Integrity experience, preferably at an AMC
• Knowledge of coding guidelines and Coding Clinic
• Understanding of laws and regulations regarding clinical documentation for Medicare and Medi-Cal
• Strong leadership and supervisory skills
• Proficient in EPIC and 3M 360 Encompass CAC, computer systems, and MS Office tools

Benefits

• Fully remote work option
• Monday - Friday schedule with defined hours
• Indefinite employment duration
• Involvement in a dynamic team with various modalities
• Opportunities for continuous learning and professional development
• Collaboration with interdisciplinary teams to improve processes