Clinical Documentation Specialist - San Francisco

Job Type: contract

Company: IDR

Job Description Apply Now

IDR is seeking a dedicated and experienced Clinical Documentation Specialist to join one of our top clients in San Francisco, CA. This role is pivotal in ensuring accurate and comprehensive clinical documentation in medical records. If you have a strong clinical background and are looking for an opportunity to join a large, growing organization with a team-oriented culture, we encourage you to apply today!

Position Overview/Responsibilities for the Clinical Documentation Specialist:

Conducting thorough record reviews and collaborating with physicians, allied health professionals, health information management teams, and nursing staff
Conducting concurrent reviews to enhance documentation accuracy and optimize severity of illness representation
Ensuring compliance with MS-DRG classification per Centers for Medicare and Medicaid Services (CMS) guidelines
Reviewing documentation for Medicare Fee-for-Service (FFS) patients and other payers identified by the organization
Prioritizing case reviews based on organizational guidelines, including APR-DRG classification and quality data elements (e.g., Patient Safety Indicators, Readmissions)

Required Skills for Clinical Documentation Specialist:

Minimum of 2 years of Clinical Documentation Improvement (CDI) experience in a complex acute care setting
Familiarity with MS-DRG and APR-DRG classification systems
Knowledge of Centers for Medicare and Medicaid Services (CMS) compliance regulations
Strong clinical expertise and ability to work collaboratively with a diverse team

What’s in it for you?

Competitive compensation package
Full Benefits; Medical, Vision, Dental, and more!
Opportunity to get in with an industry-leading organization
Close-knit and team-oriented culture

Why IDR?

25+ Years of Proven Industry Experience in 4 major markets
Employee Stock Ownership Program
Medical, Dental, Vision, and Life Insurance
ClearlyRated's Best of Staffing® Client and Talent Award winner 11 years in a row

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. IDR is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite employees to voluntarily self-identify their race or ethnicity, gender, and veteran status (if applicable). Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. You may access this form here.