Clinical Documentation Auditor/Educator (Remote)
On-site · Texas, United States
Job Summary
Clinical Documentation Improvement (CDI) Auditor Educator responsible for improving quality, completeness, and accuracy of medical record documentation across the CDI program. Conducts audits, analyzes patterns and trends, identifies opportunities for system-wide improvement, and provides education to physicians and CDIS staff. Will train and develop education materials to strengthen documentation practices and ensure accurate coding reflecting severity of illness and risk of mortality. Supports retrospective audits for hospital clients, tracks audit findings by region, and collaborates with leadership to refine audit tools and policies. Requires a BSN, Texas license, and CDI certification (CCDS/CDIP/CCS) with at least 3 years of CDI experience; experience with Epic EMR and 3M coding software is preferred. Demonstrates strong communication, analytical, and organizational skills, and serves as a resource for clinical documentation improvement, policy development, and education across system facilities.
Required Qualifications
- Bachelor of Nursing (BSN) required
- Current State of Texas nursing license or temporary/compact license
- Certified Clinical Documentation Specialist (CCDS) from AHIMA or Certified Clinical Documentation Integrity Professional (CDIP) from AHIMA or Certified Coding Specialist (CCS) from AHIMA
- Three (3) years CDI experience
- Experience with 3M Coding and Reimbursement software and Epic EMR preferred
- Strong MS Office skills (Word, Excel, Outlook)
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