Clinical Documentation Integrity Specialist

📋 Description

• • Be the bridge between clinical excellence and compliant documentation. As our Clinical Documentation Integrity Specialist, you will sit at the intersection of patient care and data integrity, ensuring that every chronic condition, every complex diagnosis, and every nuance of a patient’s story is accurately captured in the EHR. Your work directly influences risk-adjusted revenue, quality scores, and—most importantly—the resources our FQHC partners can invest back into underserved communities.
• • Own pre-visit chart reconnaissance. Two days before a provider sees a patient, you will dive deep into the medical record—lab trends, imaging results, specialist notes, medication lists—to surface undocumented or under-documented conditions. You will flag HCC-relevant diagnoses, highlight care gaps, and package concise, actionable insights so the PCP can address complexity in real time rather than after the fact.
• • Coach and educate providers in the moment. Whether it’s a five-minute huddle in the hallway or a scheduled Zoom session, you will translate CMS guidelines and HCC logic into plain language that physicians can absorb between patients. You will share before-and-after examples, quick-reference tip sheets, and real-time feedback that help clinicians understand why “mild, persistent asthma” versus “unspecified asthma” changes both quality metrics and reimbursement.
• • Conduct rigorous post-visit chart review. After the encounter, you will re-examine the documentation to confirm that the conditions discussed were captured with the correct specificity, laterality, and status indicators. You will reconcile any discrepancies, append compliant queries, and update internal dashboards so leadership can track improvement trends by provider, clinic, and condition category.
• • Supervise AI-NLP accuracy and continuous learning. Our natural-language-processing engine surfaces thousands of suggestions weekly. You will audit a statistically significant sample for false positives and negatives, feeding algorithmic refinements back to the data science team. When the model flags “CKD stage 4” but the note only supports stage 3, you will document the rationale and help tune future iterations.
• • Safeguard compliance and minimize audit risk. You will maintain a living library of CMS, HHS, and state Medicaid documentation requirements; run quarterly internal audits; and partner with compliance officers to remediate any findings. Your meticulous query log and education records will serve as evidence of good-faith efforts should an external audit occur.
• • Collaborate across multidisciplinary squads. You will join weekly huddles with care managers, pharmacists, and behavioral-health consultants to ensure documentation aligns with care-plan interventions. You will also co-present performance scorecards at FQHC board meetings, translating data into narratives that inspire clinicians and administrators alike.
• • Drive continuous process improvement. Using Excel and Power BI, you will analyze trends in missed HCC opportunities, query response rates, and provider-level performance. You will pilot new workflows—such as integrating documentation nudges into the EHR banner—and measure impact on both accuracy and provider satisfaction.
• • Champion health-equity storytelling. Accurate documentation does more than optimize revenue; it reveals the true burden of disease in marginalized populations. By ensuring that social determinants, chronic comorbidities, and severity are fully captured, you equip policy-makers and funders with the evidence needed to direct additional resources to the communities that need them most.
• • Enjoy a hybrid rhythm that balances focus and connection. Work shoulder-to-shoulder with colleagues in our downtown Chicago office every Tuesday and Wednesday for white-boarding, provider shadowing, and team lunches. Spend Mondays, Thursdays, and Fridays in your home office, diving deep into charts and data without distractions.