Remote Clinical Documentation Integrity Specialist (CDI) – RN

Position Summary

The CDI Specialist is responsible for reviewing inpatient medical records to ensure accurate, complete, and compliant clinical documentation that reflects severity of illness, risk of mortality, quality outcomes, and appropriate reimbursement.

Key Responsibilities

· Conduct concurrent and retrospective reviews of inpatient medical records.

· Evaluate documentation for completeness, specificity, and accuracy.

· Issue compliant physician queries and educate providers.

· Collaborate with coding, case management, quality, and physician teams.

· Support audits, denials management, and CDI initiatives.

· Track metrics including CMI, CC/MCC capture, query rates, SOI, and ROM.

Qualifications

· Associate or Bachelor degree in Nursing or Health Information Management preferred.

· RN, RHIA, RHIT, CCS, CCS-P, CPC, CIC, or equivalent credential.

Experience Requirements

· CDI Specialist I: 2-3 years acute care nursing or coding experience.

· CDI Specialist II: 3-5 years acute care nursing/coding plus 1-2 years CDI experience.

· Senior CDI Specialist: 5+ years CDI experience.

· CDI Educator/Lead: 5-7 years CDI plus provider education experience.

· CDI Manager: 7+ years CDI leadership experience.

· CDI Director: 10+ years CDI, coding, quality, and leadership experience.

Preferred Certifications

· CCDS

· CCDS-O

· CDIP

· CCS

· RHIA

· RHIT

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Retirement plan
• Vision insurance

Work Location: Remote