Clinical Documentation Specialist

Location:Remote

Facility:Ascension St. John Medical Center

Department/Specialty: Clinical Integrity Documentation

Schedule:FT, Monday-Friday, 8am-5pm

Salary: $79,511.52 - $110,834.59

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.

• Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
• Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
• Time to recharge: pro-rated paid time off (PTO) and holidays
• Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
• Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
• Family support: parental leave, adoption assistance and family benefits
• Other benefits: optional legal and pet insurance, transportation savings and more

Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process.

• Financial Accuracy & Revenue Cycle:This role ensures the documentation accurately reflects the patient's acuity and severity of illness. This leads to accurate diagnosis-related group (DRG) assignments, preventing undercoding (revenue loss) and overcoding (compliance risks). By capturing the full complexity of care, they reduce denied claims.
• Quality of Care and Patient Outcomes:By improving the clarity of records, this role ensures all clinicians have an accurate picture of the patient's condition, which aids in developing better care plans and avoiding gaps in care.
• Compliance and Risk Management:They ensure documentation complies with stringent regulations, such as HIPAA, and support compliance by validating that medical records align with reported diagnoses.
• Clinician Efficiency & Education:This role bridges the gap between clinical care and HIM/coding, often providing feedback and education to physicians on documentation best practices.

Licensure / Certification / Registration:

• One or more of the following required:
  
  • Certified Coding Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA).
  • Reg Health Info Admnstr credentialed from the American Health Information Management Association (AHIMA).
  • Reg Health Info Tech credentialed from the American Health Information Management Association (AHIMA).
  • Certified Professional Coder (CPC) credentialed from the American Academy of Professional Coders (AAPC).
  • Clinical Documentation Prof. credentialed from the Association of Clinical Documentation Improvement Specialists.
  • Registered Nurse credentialed from the Oklahoma Board of Nursing.

Education:

• High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.

• 3+ years of acute care nursing experience
• Clinical Documentation Improvement experience preferred
• Strong analytical skills
• Knowledge of regulatory compliance

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

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Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

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