ED CDI Specialist

? Job Title: Emergency Department Clinical Documentation Improvement (ED CDI) Specialist

? Location: Chennai/Hyderabad

? Level: L2

? Department : Clinical Documentation Improvement

? Reports To: Coding Manager

? Position Summary:

? The ED CDI Specialist is responsible for enhancing the quality and accuracy of clinical

? documentation in the Emergency Department to ensure compliance with regulatory standards,

? optimize reimbursement, and improve patient care outcomes. This role involves collaborating

? with coders, auditors, clients, physicians and other healthcare providers to ensure that

? documentation reflects the true clinical picture of patients' conditions and treatments.

? Key Responsibilities:

? Documentation Review: Perform regular audits of clinical documentation in the ED to

? identify areas for improvement, ensuring accuracy and completeness of report.

? Education and Training: Provide ongoing education and training to ED staff on best

? practices for clinical documentation, including coding guidelines and regulatory

? requirements.

? Collaboration: Work closely with Coders/QA staff/Leadership/Clients, ED physicians

? and clinical staff to clarify documentation issues and promote accurate coding and

? reporting.

? Data Analysis: Analyze documentation trends and outcomes to identify opportunities for

? improvement in clinical practices and documentation accuracy.

? Compliance Monitoring: Ensure adherence to CMS guidelines and other regulatory

? requirements related to clinical documentation.

? Feedback and Reporting: Develop and present reports on documentation improvement

? initiatives and outcomes to immediate supervisor, stakeholders and Senior leadership.

? Quality Improvement: Participate in quality improvement initiatives aimed at enhancing

? patient care and safety in the ED.

? Professional Development: Stay current with developments in clinical documentation

? and coding standards through continuing education and professional organizations.

? Qualifications:

? Education: Masters/bachelor s degree in any life science stream Medicine,

? Physiotherapy, Occupational Therapy, Physician Assistant, Nursing, Pharmacy,

? Biomedical, Biochemistry, Microbiology, health information management, or related field.

? Experience: Minimum of 4-5 years of clinical experience in an emergency department

? setting, with at least 2 years in clinical documentation improvement or coding.

? Certifications: CPC, Certified Clinical Documentation Specialist (CCDS), Certified

? Documentation Integrity Practitioner (CDIP) or equivalent certification preferred.

? Skills: Strong knowledge of medical terminology, anatomy, physiology, coding

? guidelines (ICD-10, CPT, Modifiers, Category II codes), and clinical documentation

? standards with Excellent communication, analytical, and problem-solving skills.

? Technology Proficiency: Proficiency in electronic health record (EHR) systems and

? clinical documentation improvement software.

? Work Environment:

? Primarily in the Emergency Department with interactions across various departments.

? Ability to work in a fast-paced clinical environment in a US shift time zone.

? Work from office is mandatory

? Renumeration:

? Best as per the market standards