Outpatient Clinical Documentation Integrity Specialist

About the role

The Outpatient Clinical Documentation Integrity (CDI) Specialist enhances accuracy and compliance of clinical documentation within a multi‑facility PACE healthcare system.

Responsibilities

• Conduct prospective, concurrent, and retrospective chart reviews across various care settings to identify documentation gaps and improvement opportunities.
• Support compliant HCC capture and RAF accuracy for Medicare Advantage, Medicaid, and PACE populations in line with CMS guidelines.
• Ensure diagnoses are clinically supported, meet CMS requirements, and include appropriate linkages.
• Develop provider queries for clarification and collaborate with coding teams to support accurate ICD‑10‑CM coding and documentation.
• Educate providers on documentation standards, chronic condition capture, and risk adjustment practices.
• Participate in audits, quality assurance, and monitor documentation trends to recommend process improvements.
• Evaluate EHR workflows and maintain compliance with CMS regulations and organizational policies.

Qualifications

• Active clinical license (RN, PA, NP, MD/DO) or equivalent experience; certifications such as CCDS, CDIP, CCS, CPC preferred.
• Minimum three years of experience in clinical documentation improvement, outpatient CDI, or related fields.
• Strong knowledge of ICD‑10‑CM guidelines, CMS risk adjustment, HCC models, and MEAT criteria.
• Excellent analytical, communication, and collaboration skills, with the ability to prioritize and work independently.
• Commitment to ethical practices, continuous learning, and improving documentation quality.

Skills

• Critical thinking
• Detail‑oriented
• Effective communication
• Collaborative mindset
• Adaptability to evolving regulations