Clinical Documentation Improvement Lead

Job Description

Job Description

ESSENTIAL FUNCTIONS
• Lead clinical documentation improvement initiatives focused on orthopedic and musculoskeletal specialties
• Review provider documentation for completeness, specificity, medical necessity, and coding accuracy
• Partner with physicians, APPs, coding teams, and operational leaders to improve documentation workflows and reduce
revenue leakage
• Identify trends impacting reimbursement, denials, downcoding, charge lag, and documentation deficiencies
• Provide education and real-time feedback to providers regarding coding, documentation standards, payer requirements,
and compliance expectations
• Serve as a subject matter expert for Athena documentation workflows, claim edits, charge capture, and operational
reporting
• Collaborate with coding and denial management teams to resolve documentation-related reimbursement issues
• Support audit readiness and compliance initiatives through routine chart reviews and documentation monitoring
• Assist in the development and maintenance of documentation policies, workflows, tip sheets, and provider education
materials
• Analyze documentation and coding trends to support operational performance improvement and financial optimization
• Monitor payer policy changes and regulatory updates impacting MSK documentation and reimbursement
• Participate 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