Outpatient Clinical Documentation Integrity Specialist

Job Type Full-time Description Job Title: Outpatient Clinical Documentation Integrity Specialist Job Description Founded in 1991, IBJI is the largest orthopedic group practice in Illinois. With more than 150 physicians in every orthopedic specialty, IBJI offers care for adults and children from some of the most accomplished and respected orthopedists in the country. Serving northern Illinois and northwest Indiana with over 100 locations, IBJI makes it easy to access care. Our headquarters is in Park Ridge, Illinois, a northwest suburb of Chicago. Our clinical services include advanced MRI imaging, pain management, non-surgical and surgical treatment plans, rheumatology, physical therapy, occupational therapy, wellness, and sports training. Ortho Access walk-in clinics provide same day care for orthopedic injuries. Comprehensive care offered all in one place enables physicians, therapists and staff to work closely together, so that patients and families achieve better outcomes. Collaborative care is also more efficient. In many cases, IBJI services are substantially less expensive than those provided by large healthcare systems and emergency rooms. Summary The Outpatient Clinical Documentation Integrity (CDI) Specialist is responsible for improving the accuracy, completeness, and integrity of outpatient clinical documentation and coding across Illinois Bone & Joint Institute. This role performs prospective and retrospective audits, provides timely provider feedback and education, manages documentation and coding send-backs, and partners closely with coding, Revenue Cycle, and Epic teams to support compliant and accurate charge capture. The specialist also audits AI-assisted coding output, identifies documentation and revenue integrity opportunities, monitors trends, and supports workflow and system improvements that strengthen coding quality, reduce rework and denials, and ensure services are accurately represented and billed. Responsibilities Performs prospective and retrospective audits of outpatient clinical documentation, coding, and charge capture to validate accuracy, completeness, medical necessity, and compliance with applicable coding and payer requirementsReviews provider documentation and coded services for appropriate diagnosis, CPT, HCPCS,modifier, and E/M code selection and identifies opportunities for clarification or correctionProvides clear, timely, and actionable feedback to physicians, advanced practice providers, coders, and operational teams regarding documentation and coding findingsDevelops and delivers provider education based on audit findings, coding trends, payer changes, regulatory guidance, and identified documentation opportunitiesManages and monitors documentation and coding send-backs, including appropriate follow-up with providers and coders to support timely resolution and claim submissionPartners with coding leadership and coding staff to review recurring coding questions, reconcile documentation and coding discrepancies, and promote consistent coding practicesCoordinates with the Epic team on Revenue Cycle and CDI-related workflow, edit, workqueue, reporting, charge capture, and documentation enhancement opportunities; participates in testing and user acceptance testing (UAT) as neededAudits AI-assisted and automated coding output for accuracy, compliance, and consistency; identifies error patterns, documents findings, and collaborates with coding and technology teams on corrective actions and optimizationSupports Revenue Integrity activities, including review of charge capture, missed or incorrect charges, coding edits, modifier use, billing rules, and workflow opportunities that may affect compliant reimbursementIdentifies trends that may contribute to denials, claim edits, delayed billing, coding rework, or revenue leakage and partners with Revenue Cycle teams to develop sustainable solutionsAssists with the development and maintenance of coding, CDI, and Revenue Integrity policies, procedures, tip sheets, education materials, and standardized workflowsTracks and reports audit results, provider education activity, send-back volumes, error trends, and improvement opportunities; escalates significant or recurring findings to leadershipParticipates in Revenue Cycle change control, Epic optimization, and process improvement initiatives that impact coding, documentation, charge capture, and claimsMaintains current knowledge of ICD-10-CM, CPT, HCPCS, NCCI edits, payer policies, Medicare requirements, and other applicable coding and billing guidanceMaintains confidentiality of patient information in accordance with HIPAA and organizational policiesSupports departmental goals, quality initiatives, and other Revenue Cycle responsibilities as assignedMaintain a clean and safe work environmentOther duties as assigned Requirements Requirements Education Associate degree in Health Information Management, Health Information Technology, Nursing, or a related healthcare field preferred; equivalent relevant experience may be considered Certifications/Licensure Current professional coding credential such as CPC, CCS, CCS-P, or equivalent strongly preferredCPMA, CDIP, CCDS-O, or other auditing/CDI credential preferred Experience Minimum of three years of professional fee outpatient coding, coding auditing, CDI, or Revenue Integrity experience preferredOrthopedic, musculoskeletal, or multi-specialty physician practice experience strongly preferredExperience providing physician/provider education and communicating audit findings preferredExperience with Epic, including professional billing workflows, workqueues, edits, or reporting, preferredExperience reviewing computer-assisted coding, autonomous coding, or AI-supported coding solutions preferred Technical Skills Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, E/M coding, NCCI edits, and professional fee coding guidelinesAbility to interpret clinical documentation, payer policies, and coding guidance and apply them consistently to outpatient servicesStrong analytical skills with the ability to identify trends, root causes, and revenue cycle improvement opportunitiesProficiency with electronic health records, coding systems, Microsoft Office applications, and data/reporting tools Soft Skills Excellent verbal and written communication skills with the ability to provide constructive, credible feedback to providers and staffAbility to educate and influence through collaboration while maintaining a compliance-focused approachHighly detail-oriented with strong organization, follow-up, and prioritization skillsAbility to work independently while partnering effectively across Coding, Revenue Cycle, Epic/IT, clinical operations, and provider leadershipDemonstrates sound judgment, professionalism, curiosity, and a continuous improvement mindset Physical Requirements Requires prolonged periods of sitting and computer useFrequent use of keyboard, mouse, telephone, and other standard office equipmentAbility to work effectively in a fast-paced healthcare office environment and manage multiple priorities This description is intended to provide only basic guidelines for meeting job requirements. Duties and responsibilities, experience, qualifications, skills, supervisory relationship, physical/mental demands, and environmental/ working conditions may change as needs evolve. Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week): medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off. Illinois Bone and Joint Institute, LLC is an equal opportunity employer. All employment decisions are based on qualifications, merit, and business need, without regard to race, color, religion, age, sex, national origin, disability status, military or veteran status, sexual orientation, gender identity and expression, or any other characteristic protected by federal, state or local laws. This policy applies to recruitment and placement, promotion, training, transfer, retention, rate of pay and all other terms and conditions of employment.