Clinical Documentation Integrity Specialist

UASI is a mission-driven organization dedicated to improving the quality and accuracy of clinical documentation through expert consulting. We are currently seeking experienced Clinical Documentation Integrity Specialists to join our fully remote team and contribute to the accuracy of coded data and the quality of clinical outcomes reporting.

Key responsibilities

• Review and evaluate medical record documentation for completeness, accuracy, and compliance.
• Collaborate with physicians, nurses, and coding professionals to ensure appropriate clinical documentation.
• Identify opportunities for documentation improvement to support coding accuracy, reimbursement, and clinical outcomes.
• Analyze medical records to ensure documentation supports quality care and appropriate reimbursement.
• Formulate compliant, clinically sound physician queries.

Requirements

• Minimum of 2 years of clinical documentation improvement experience.
• Registered Nurse (RN) certification.
• Strong knowledge of ICD-10-CM, MS-DRGs, coding guidelines, and compliance standards.
• Excellent communication, critical thinking, and organizational skills.
• Proficiency with MS Office, VPNs, virtual machines, and video conferencing tools.

What we offer

• A collaborative, mission-driven team environment.
• Opportunities for continuous learning, education, and professional growth.
• Leadership that values your expertise and input.
• A comprehensive benefits package and competitive compensation.