Clinical Documentation Integrity Specialist

Job description:

Location: Makati City
Work Setup: Work From Home (WFH)
Salary: Up to PHP 100,000
Employment Type: Full-Time
Start Date: ASAP

Job Summary

We are looking for an experienced and detail-oriented Clinical Documentation Integrity Specialist (CDI Specialist) to support accurate and compliant clinical documentation practices within a U.S. healthcare setting. The ideal candidate will have strong inpatient clinical experience, CDI expertise, and knowledge of ICD-10 coding guidelines and DRG reimbursement systems. This role is responsible for reviewing medical records, improving documentation quality, and collaborating with healthcare providers to ensure accurate clinical representation and reimbursement.

Key Responsibilities

• Review inpatient medical records to ensure documentation accuracy, completeness, and compliance with coding and regulatory guidelines.
• Conduct concurrent and retrospective chart reviews to identify documentation gaps and opportunities for clarification.
• Collaborate with physicians, coders, case managers, and clinical teams to improve clinical documentation quality.
• Issue physician queries to clarify diagnoses, procedures, severity of illness (SOI), and risk of mortality (ROM).
• Ensure accurate DRG assignment and reimbursement optimization while maintaining compliance standards.
• Apply knowledge of ICD-10 Official Coding Guidelines, CMS regulations, and payer requirements.
• Support quality improvement initiatives related to clinical documentation integrity and coding accuracy.
• Monitor trends and provide recommendations for documentation improvement and compliance enhancement.
• Participate in audits, quality assurance activities, and educational sessions related to CDI processes.
• Maintain productivity and quality metrics in a fast-paced remote work environment.

Qualifications

• Active Philippine Registered Nurse (RN) license required.
• Minimum of 3 years of experience in Clinical Documentation Improvement (CDI).
• Minimum of 3 years of adult acute care hospital bedside experience in Med/Surg, Critical Care, Emergency Room (ER), or PACU settings.
• CCDS and/or CDIP certification required.
• Coding credentials such as CCS, CPC, or CCS-P are highly preferred.
• Strong understanding of ICD-10 Official Coding Guidelines and DRG Reimbursement Systems.
• Experience in U.S. healthcare, CDI review, utilization review, or medical coding is an advantage.
• Excellent analytical, communication, and documentation review skills.
• Ability to work independently in a remote setup while meeting productivity and quality expectations.

Preferred Skills

• Knowledge of CMS regulations and medical necessity review.
• Familiarity with EHR systems and encoder tools.
• Strong attention to detail and critical thinking skills.
• Ability to communicate effectively with providers and cross-functional teams.
• Strong organizational and time management skills.

Work Location: Remote