Lead Clinical Documentation Specialist

About the role

The Lead Clinical Document Specialist (CDS) – Rapid Response serves as a high-level clinical documentation integrity expert, deployed to address urgent, complex, or high-impact issues across the CDI program. This role supports strategic initiatives, facilitates rapid-cycle audits, and investigates documentation and coding anomalies in real-time. The Rapid Response Lead works collaboratively across departments to drive accurate documentation, coding integrity, and risk adjustment capture, while supporting training, compliance, and data-driven decision-making.

Responsibilities

• Serve as the primary resource for urgent CDI issues (e.g., payer denials, audits, DRG validation).
• Address immediate system needs (e.g., high denial rates, quality issues, new coding rules).
• Mentor front-line CDSs on complex cases, query framing, and escalation.
• Analyze documentation and coding data for trends and improvement.
• Lead and ensure compliance of strategic CDI initiatives across markets/systems.
• Evaluate strategic results and recommend implementation pathways.

Requirements

• Licensure / Certification / Registration: Required Credential(s) Clinical Documentation Prof. credentialed from the Association of Clinical Documentation Improvement Specialists obtained prior to hire date or job transfer date.
• Education: High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree with 1 year of experience OR 5 years of applicable cumulative job specific experience required. 2 years of leadership or management experience preferred.

Preferences

• Lead experience
• Project Management experience
• CCDS Certified