A Clinical Documentation Specialist is a healthcare professional who is responsible for maintaining and ensuring the accuracy of medical records. They also work towards making sure that the documentation aligns with the coding guidelines and legal requirements.
Clinical Documentation Specialists work in various healthcare institutions, including hospitals, clinics, and health departments. Their main duty is to review and verify the patients' medical records and make sure they are complete. They also ensure that these records can be easily understood and follow the required standards.
With increasing emphasis on data and records in healthcare, Clinical Documentation Specialists are in high demand. There are opportunities to work in diverse healthcare settings, with interesting roles and potential for professional growth and progression.
Quality Improvement Specialist, New York City
$82K *
Unlock your potential as a Quality Improvement Specialist, guiding early childhood programs in continuous improvement through hands-on support, data-driven strategies, and collaboration with community...
Reposted 2 weeks ago
$110K - $143K *
Transform compliance operations into audit-ready practices while managing evidence collection and control monitoring across multiple business units. Collaborate closely with security assessors to rein...
3 days ago
Nurse Case Manager l - California HMO
$73K - $120K *
Join a dedicated team as you manage complex care for members, ensuring seamless access to necessary services, assessments, and coordinated care plans to enhance health outcomes. Work remotely while ma...
1 week ago
Nurse Case Manager l - California HMO
$73K - $120K *
Join a team that optimizes healthcare for members with chronic needs through effective assessment, planning, and coordination. You'll leverage clinical expertise to enhance member well-being while wor...
1 week ago
Nurse Case Manager l - California HMO
$73K - $120K *
Collaborate to enhance patient care as a Nurse Case Manager, engaging with members and providers. You'll assess, develop, and monitor care plans for complex needs, ensuring effective health service ac...
1 week ago
Nurse Case Manager l - California HMO
$73K - $120K *
Transform member care by managing complex health needs through assessments, care planning, and resource coordination. This remote role fosters efficiency and collaboration, ensuring optimal health out...
1 week ago
Nurse Case Manager l - California HMO
$73K - $120K *
Lead care management for members with complex health needs, ensuring optimal access to services and effective care plans. Collaborate with providers and assess individual needs to enhance health outco...
1 week ago
Nurse Case Manager l - California HMO
$73K - $120K *
Drive effective care management for members with complex needs by assessing and coordinating comprehensive care plans. Collaborate with providers and resources to optimize healthcare outcomes while wo...
1 week ago
Nursing Professional Development Practitioner
$68K - $126K *
Elevate capabilities by designing and implementing educational programs while evaluating learner outcomes in nursing education. Collaborate with staff to enhance professional development and foster a...
4 days ago
HCS Applications Systems Analyst - Epic Cadence & Welcome - ISD Business and Revenue Cycle Systems
$69K - $99K *
Optimize IT resources by providing technical support for application development and implementation, ensuring seamless integration across systems while enhancing business functions within the health s...
1 week ago
Coding Compliance Auditor - Maui Health
$79K - $93K *
The Coding Compliance Auditor will coordinate, monitor, and audit documentation and coding of inpatient and outpatient services to ensure compliance with regulatory guidelines. This role involves anal...
Reposted 3 days ago
$90K - $99K *
Drive effective MDS assessments and compliance in a supportive team environment. Ensure quality care and operational excellence through collaboration, supervision, and continuous improvement initiativ...
1 week ago
$80K - $105K *
Play a key role in ensuring accurate MDS assessments and compliance. Supervise data processes, address operational issues, and engage in quality improvement initiatives to support enhanced patient car...
1 week ago
Manager, HIM (Facility Coding)
$75K - $95K *
Join a team that's dedicated to optimizing healthcare data quality through effective coding management and collaboration across departments, ensuring compliance and enhancing patient care processes in...
3 days ago
Region Manager Revenue Cycle Inpatient Coding-NW
$90K - $120K *
Inspire excellence by overseeing inpatient coding teams, ensuring compliance and performance alignment with enterprise goals while fostering collaborative relationships across multiple departments...
5 days ago
$115K *
Empower patients through exceptional culinary leadership that elevates food service quality. Collaborate with a dedicated team to create a welcoming hospital environment, delivering nutritious meals a...
Reposted 2 days ago
$100K - $112K *
Transform healthcare nutrition by leading a skilled team of Dietitians, implementing innovative nutrition strategies, and enhancing patient care through collaboration and evidence-based practices. Fos...
1 week ago
Director of Patient Care Services (DPCS)
$130K - $150K *
Make your mark at a leading home healthcare agency, overseeing patient care services, ensuring quality compliance, and managing a dedicated team to deliver exceptional care while supporting personal a...
Reposted today
$80K - $95K *
Lead the charge in delivering exceptional nursing care with a focus on regulatory compliance and operational excellence, ensuring a high standard of client service and staff management within the trea...
Reposted 2 weeks ago
Senior Claims Examiner, Casualty
$123K - $191K *
Drive comprehensive claims management for high severity commercial accounts, focusing on general liability and auto, while ensuring strategic resolution and effective communication with stakeholders i...
3 weeks ago
HCS Apps Systems Analyst - Epic OpTime / Anesthesia
$69K - $99K *
Enhance surgical services IT tools by developing, testing, and implementing Epic OpTime and Anesthesia workflows, while collaborating with operational teams to optimize functionality and troubleshoot...
1 week ago
HCS Apps Systems Analyst - Epic OpTime / Anesthesia
$69K - $99K *
Transform surgical services by optimizing Epic OpTime and Anesthesia workflows. Collaborate, innovate, and troubleshoot to enhance IT support for operational teams across the health system, while adhe...
1 week ago
$95K - $110K *
Revolutionize revenue cycle operations with your leadership expertise, managing financial processes from provider credentialing to claims adjudication, while optimizing workflows and safeguarding reve...
2 days ago
$80K - $100K *
Grow your career with us by providing vital clinical expertise in continence care. Engage with customers through education and training, collaborate with teams, and drive successful product implementa...
5 days ago
Configuration Management Specialist
$75K - $95K *
Manage configuration management processes ensuring traceability and integrity of system requirements and design documentation. Regularly evaluate change control and support quality assurance audits fo...
4 days ago
What is a Clinical Documentation Specialist?
A Clinical Documentation Specialist is a healthcare professional responsible for the accuracy and completeness of medical records. They ensure these records meet coding guidelines and legal requirements.
Where can Clinical Documentation Specialists work?
Clinical Documentation Specialists work in a variety of healthcare settings such as hospitals, clinics, and health departments.
What is the average salary for Clinical Documentation Specialist jobs?
The average salary can vary depending on the location and the company. However, on Ladders, you can find Clinical Documentation Specialist jobs that pay over $100000.
What qualifications do I need to become a Clinical Documentation Specialist?
Typically, a Clinical Documentation Specialist requires a degree in health informatics or a similar field and some prior experience in a healthcare setting. Further, professional certification may enhance job prospects.