Clinical Documentation Improvement Lead

Clinical Documentation Improvement Lead

Essential functions include leading clinical documentation improvement initiatives focused on orthopedic and musculoskeletal specialties, reviewing provider documentation for completeness, specificity, medical necessity, and coding accuracy, partnering with physicians, APPs, coding teams, and operational leaders to improve documentation workflows and reduce revenue leakage, identifying trends impacting reimbursement, denials, downcoding, charge lag, and documentation deficiencies, providing education and real-time feedback to providers regarding coding, documentation standards, payer requirements, and compliance expectations, serving as a subject matter expert for Athena documentation workflows, claim edits, charge capture, and operational reporting, collaborating with coding and denial management teams to resolve documentation-related reimbursement issues, supporting audit readiness and compliance initiatives through routine chart reviews and documentation monitoring, assisting in the development and maintenance of documentation policies, workflows, tip sheets, and provider education materials, analyzing documentation and coding trends to support operational performance improvement and financial optimization, monitoring payer policy changes and regulatory updates impacting MSK documentation and reimbursement, and participating in cross-functional operational meetings and revenue cycle performance initiatives.

Education: Certified Professional Coder (CPC), CCS, RHIA, RHIT, or equivalent coding certification required.

Experience: Minimum 5 years of clinical documentation improvement, coding, or revenue cycle experience in orthopedic/MSK specialties required. Strong working knowledge of musculoskeletal and orthopedic procedural and diagnosis coding.

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