Lead, CDI Specialist

What We Are Looking For

We are seeking an experienced Lead Clinical Documentation Improvement (CDI) Specialist to provide clinical and operational leadership that advances the quality, consistency, and effectiveness of our Clinical Documentation Improvement program. This role will oversee quality assurance activities, staff education, regulatory compliance, documentation excellence, and continuous program optimization while supporting ongoing program growth and expansion.

The Lead CDI Specialist will serve as a subject matter expert, partnering with providers, health centers, and internal stakeholders to enhance documentation accuracy, coding specificity, risk adjustment capture, and overall program performance.

Key Responsibilities

• Lead and maintain the CDI Quality Assurance (QA) program, including audits, quality monitoring, staff feedback, trend analysis, and identification of improvement opportunities.
• Monitor CMS guidance, ICD-10-CM coding standards, risk adjustment methodologies, HCC models, and payer requirements, ensuring timely communication of regulatory and industry updates to CDI staff.
• Develop and deliver CDI education and training based on regulatory changes, audit findings, documentation trends, and program needs.
• Lead provider and health center education initiatives, including the development of presentations, training materials, job aids, and documentation resources.
• Conduct prospective medical record audits to identify documentation, coding, clinical specificity, and risk adjustment opportunities.
• Analyze audit findings and trends to develop actionable recommendations and improvement strategies.
• Drive continuous CDI program optimization by evaluating and improving workflows, processes, tools, and operational standards.
• Serve as a CDI subject matter expert, providing guidance and support to CDI staff, providers, and health center stakeholders.
• Support CDI program expansion across new health centers, providers, patient populations, and value-based care contracts.
• Collaborate with clinical, operational, and technical teams to support organizational goals and improve outcomes.

Required Qualifications

• Current professional certification required (CCS, CPC, CRC, RHIT, RHIA, or equivalent).
• Minimum of five (5) years of experience in Clinical Documentation Improvement, coding audits, risk adjustment, quality assurance, or related healthcare operations.
• Advanced knowledge of ICD-10-CM coding standards, risk adjustment methodologies, HCC models, and applicable regulatory requirements.
• Experience conducting documentation reviews, prospective audits, and quality assurance activities.
• Strong analytical, critical thinking, and process improvement skills.
• Excellent written, verbal, presentation, and stakeholder engagement skills.
• Ability to manage multiple priorities and collaborate effectively across cross-functional teams.

Preferred Qualifications

• Associate's or Bachelor's degree in Health Information Management, Nursing, Healthcare Administration, or a related field.
• Experience leading CDI quality assurance programs and educational initiatives.
• Experience supporting value-based care programs and risk adjustment strategies.
• Previous provider education and training experience.
• Experience supporting program growth, implementation, and operational improvement initiatives.

Why You'll Love Working With Us

✅ 100% Remote Work – Work from anywhere in the U.S.
✅ 100% Employer-Paid Medical Insurance on one of our health plans
✅ Annual $1,500 HSA Contribution
✅ Generous Paid Time Off (PTO)
✅ 403(b) Retirement Plan with Employer Contribution
✅ Professional Development & Education Assistance
✅ Mission-Driven Culture Focused on Community Health

Disclaimer

At this time, Health Choice Network is not able to employ individuals who reside or work in California. Applicants must reside and perform work in an approved state at the time of hire and throughout employment.