UCLA Health

Clinical Documentation Integrity Specialist

UCLA Health$100K — $218K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 5+ years of experience in clinical documentation integrity or denial management
  • Strong understanding of medical coding and regulatory guidelines
  • Proficient in analyzing clinical data for denial trends and documentation improvement
  • Effective communication skills for educating various medical staff
  • Ability to prepare compelling appeal letters with supporting clinical evidence

Responsibilities

  • Review high-acuity patient records to identify payer denials
  • Assess clinical validity for both inpatient and outpatient services
  • Educate physicians and clinical staff on documentation strategies
  • Collaborate with multiple departments to enhance documentation quality
  • Analyze denial trends and provide actionable feedback to teams
  • Prepare and submit high-quality appeal letters based on regulatory criteria

Benefits

  • Flexible work arrangements
  • Professional development opportunities
  • Collaborative team environment
  • Access to the latest coding and documentation resources
  • Support for ongoing education and certifications
Full Job Description
You will become a member of our highly successful Clinical Documentation Integrity and Denial Management team, including all modalities. This role involves daily review of high-acuity patient records to identify potential and active payer denials, assess clinical validity, and to support denial prevention, analysis, and appeals across inpatient and outpatient settings; continuously communicating with department staff; educating physicians, residents, and mid-levels; and assisting with appropriate documentation strategies. Partnering with Medical Coding, Clinical Documentation Integrity, Case Management, and the Quality team, you will gather/analyze information to provide comprehensive medical record documentation that accurately reflects clinical treatment, decisions, and diagnoses. Leveraging your denial management experience, clinical expertise, and coding knowledge to identify opportunities and ensure accuracy and completeness of clinical documentation for denial prevention. You will prepare and submit high quality appeal letters supported by clinical evidence, regulatory guidelines, and payor-specific medical necessity criteria, while identifying denial trends and root causes and provide feedback to the CDI and Clinical teams. Salary Range: $100,161.36 - $218,718.00/year

About UCLA Health

UCLA Health is a world-renowned academic medical center located in Los Angeles, California. It comprises four hospitals, including Ronald Reagan UCLA Medical Center, and more than 200 primary and specialty care clinics. UCLA Health is affiliated with the David Geffen School of Medicine at UCLA and is consistently ranked among the top hospitals in the United States. The health system employs over 20,000 people and serves as a major center for patient care, medical education, and research.
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