Clinical Documentation Specialist

4 weeks ago


Towson, United States University of Maryland Medical System Full time
Job Description

Overview

  • Under the direction of the Site Manager of the Clinical Documentation Integrity (CDI) program, the Clinical Documentation Specialist (CDS) strives to achieve accurate and complete documentation in the inpatient medical record to support precise ICD-10-CM and ICD-10-PCS coding and reporting of high-quality healthcare data. The CDS is guided by the Association of Clinical Documentation Integrity Specialists (ACDIS) “Code of Ethics” and the American Health Information Management Association’s (AHIMA) “Ethical Standards for Clinical Documentation Integrity Professionals” and the Official Guidelines for Coding and Reporting as approved by the Cooperating Parties.

Qualifications

Qualifications

  • Education · Registered Nurse (RN), Physician (MD), Physician Assistant (PA) , Certified Registered Nurse Practitioner (CRNP), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

Experience ·

  • Licensures/Certifications · Must obtain certification as a Certified Clinical Documentation Specialist (CCDS) via ACDIS or a Certified Documentation Integrity Practitioner (CDIP) via AHIMA within 2 years of hire or eligibility.


Additional Information

All your information will be kept confidential according to EEO guidelines.



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