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.
Clinical Provider Auditor II - Payment Integrity SIU
$58K - $107K *
Lead critical audits in healthcare payment integrity by assessing claims, preventing fraud, and collaborating with teams to enhance compliance. Drive risk management initiatives and contribute to bett...
3 weeks ago
Clinical Provider Auditor II - Payment Integrity SIU
$58K - $107K *
Join us to enhance healthcare integrity by auditing claims for compliance and identifying fraud risks. Collaborate with teams, conduct critical analyses, and play a key role in training others while w...
3 weeks ago
Clinical Provider Auditor II - Payment Integrity SIU
$58K - $107K *
Engage in auditing healthcare claims to identify fraud and compliance risks. Collaborate with teams to improve processes and support training for new hires. Maintain knowledge of coding regulations to...
3 weeks ago
Clinical Provider Auditor II - Payment Integrity SIU
$58K - $107K *
Optimize healthcare compliance by examining claims to identify fraud and abuse risks. Collaborate with the Special Investigation Unit to develop loss control strategies and conduct training for associ...
3 weeks ago
Clinical Provider Auditor II - Payment Integrity SIU
$58K - $107K *
Take ownership of identifying fraud and abuse risks through detailed claims examination and analysis. Collaborate with internal teams to recommend interventions and remain updated on medical coding re...
3 weeks ago
Epic Clinical Analyst II, Ambulatory
$85K - $100K *
Optimize the clinical data management process by developing and supporting Epic EMR applications, ensuring effective workflows and compliance with federal initiatives while collaborating with clinical...
3 days ago
Associate Director of Inpatient Coding (CCS, RHIT, or RHIA cert required) - REMOTE
$100K - $120K *
Unlock potential by leading coding operations across specialties, analyzing performance, and ensuring quality in professional and outpatient coding. Drive strategic goals and enhance departmental effe...
Reposted 1 week ago
Coding Manager - Epic Professional Billing
$90K - $130K *
Unlock potential by overseeing global coding operations to ensure compliance, accuracy, and efficiency in coding processes. Collaborate with teams to enhance coding practices and manage relationships...
2 weeks ago
Clinical Nurse Specialist - Complex Medical - CNS
$95K - $115K *
Transform patient care by collaborating in a complex medical unit, enhancing quality and outcomes through advanced practice leadership and evidence-based initiatives across multiple nursing spheres of...
4 days ago
$104K - $159K *
Join a team that's dedicated to optimizing care for CEI participants by managing resource allocation and facilitating smooth transitions from hospital to care facilities, ensuring quality outcomes and...
1 week ago
$86K *
Accelerate progress at the intersection of clinical expertise and coding accuracy. You’ll lead initiatives that enhance documentation practices and ensure compliance, fostering collaboration with heal...
3 weeks ago
Clinical Quality Consultant NP
$85K - $100K *
Transform clinical quality by ensuring accurate coding and documentation. Leverage expertise to enhance HCC/Risk Adjustment processes while guiding provider practices to achieve optimal care and compl...
Yesterday
Risk Adjustment Coding Specialist
$80K - $95K *
Unlock potential by owning retrospective CDI chart reviews to enhance coding compliance and optimize risk adjustment across Medicare-focused primary care. Collaborate cross-functionally to ensure accu...
Today
$120K - $145K *
Drive the evolution of medical payment policies as a subject matter expert, collaborating closely with clients to analyze data, present insights, and advocate for strategic policy adoption. Shape the...
4 weeks ago
Clinical Informatics Specialist - Clinical Services
$85K - $100K *
Lead the optimization of clinical workflows and applications in a dynamic healthcare environment. Join us in enhancing patient care through data-driven decision making and collaboration across clinica...
1 week ago
QA Documentation Specialist III
$75K - $95K *
Advance quality assurance processes by overseeing validation documentation, ensuring compliance with industry standards, and collaborating across teams to enhance operational effectiveness in a dynami...
4 weeks ago
Medical Review Specialist III (DRG Claims)
$80K - $95K *
Transform healthcare review processes by conducting thorough claims assessments to ensure accurate payment determinations for Medicare DRG Inpatient Acute Hospital admissions, while maintaining compli...
Today
DLP / Desk Level Procedure Specialist
$105K - $135K *
Transform healthcare operations by designing and optimizing Desk Level Procedures (DLPs) for payer workflows, enabling teams to resolve issues effectively while ensuring compliance and operational exc...
4 days ago
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
$90K - $110K *
Shape the future of clinical quality by leading provider documentation efforts, ensuring accurate coding and compliance while driving value capture initiatives and high-quality care. Collaborate with...
Yesterday
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
$95K - $115K *
Manage clinical performance and quality coding efforts, ensuring accurate diagnosis coding and compliance. Lead training, develop performance plans, and oversee auditing processes to enhance documenta...
Yesterday
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
$90K - $110K *
Shape the future of clinical performance by leading quality coding initiatives, ensuring accurate documentation and compliance, and managing a team to enhance operational efficiency and elevate health...
Yesterday
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
$100K - $120K *
Optimize clinical performance and quality coding by leading teams and ensuring accurate diagnosis coding, while driving value capture initiatives for high-quality documentation and training for provid...
Yesterday
Clinical Director of Reimbursement
$100K - $120K *
Provide leadership in managing MDS processes, ensure compliance with CMS regulations, and oversee reimbursement strategies across facilities while supporting clinical documentation improvement and tra...
Today
$80K - $95K *
Lead the integration of healthcare clinics into our organization, ensuring seamless transitions and compliance. Collaborate with cross-functional teams to standardize operations and support organizati...
1 week ago
$66K - $100K *
Transform healthcare denials management by analyzing data and creating metrics, tracking trends, and identifying root causes. Collaborate across departments to enhance processes and ensure timely resp...
2 weeks 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.