Clinical Documentation Improvement Coordintor

Clinical Documentation Improvement Coordinator

Summary :

Responsible for reviewing medical records for completeness by monitoring the healthcare providers’ compliance about recording the patient’s medical related data (treatments, medications, requests) to support the accurate assignment of codes.

Essential Responsibilities and Duties :

• Provides advanced level review of inpatient medical records to identify gaps in clinical documentation.
• Ensures consistency of data captured by strictly following existing guidelines and constantly providing timely feedback to healthcare providers.
• Follows-up with the healthcare providers regarding existing clarifications to obtain needed documentation specification.
• Engages healthcare providers in ongoing educational sessions in regards to documentation improvement.
• Reports any gaps, lack of compliance, and findings in the medical records to the responsible Manager or Team Leader.
• Engages medical staff in the process of reviewing clinical documentations for better awareness and smooth knowledge transfer.
• Maintains a record of clinical documentation reviews performed and the gaps identified.
• Performs other related duties as assigned.

Job Requirements

Seniority level

Employment type

Job function

Industries

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