Senior Clinical Documentation Integrity Specialist

Senior Clinical Documentation Integrity Specialist

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

The Senior Clinical Documentation Integrity Specialist ensures accurate, complete, and compliant clinical documentation that appropriately reflects severity of illness, risk of mortality, and supports correct reimbursement. This role partners closely with providers, coding teams, and practice participants to drive documentation quality, regulatory compliance, and value-based care initiatives.

How You Contribute to the Company's Mission In This Role

• Develops and implements standard processes, job aids, and error prevention tools to strengthen clinical documentation integrity across participating practices.
• Educates providers and office staff on best-practice clinical documentation standards to ensure accuracy, completeness, and compliance.
• Conducts prospective and retrospective reviews and prepares analyses and reports to identify trends, gaps, and improvement opportunities.
• Provides guidance and consultation to internal practice staff to improve coding proficiency and documentation accuracy.
• Collaborates with population health and practice teams to support quality programs, value-based initiatives, and standardized data abstraction processes.
• Advises practice staff on compliance with applicable federal, state, and local regulations related to Medicare coding and documentation guidelines.

Required Qualifications

• Bachelor's degree in a related field.
• Minimum of 5 years of experience in Clinical Documentation Integrity (CDI) or coding
• At least 3 years of experience supporting healthcare value-based programs, including Medicare Risk (experience may run concurrently)
• At least one required certification, such as CPC, CRC, CCS‑P, CCS‑H, RHIT, CCDS, or CDIP
• Advanced knowledge of ICD‑10 coding guidelines and clinical documentation standards
• Strong understanding of CMS quality programs, HCCs, value‑based care models, and EHR systems
• Excellent written, verbal, interpersonal, and presentation skills
• Advanced proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook)
• Strong critical thinking, problem‑solving, and time‑management skills

Preferred Qualifications

• Master's degree in Nursing, Advanced Practice Registered Nurse (APRN), or Information Management Professional (MIM)
• Advanced knowledge of preventive health standards and clinical standards of care
• Experience collaborating with population health teams and multi‑disciplinary clinical stakeholders

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact View email address on click.appcast.io for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.