Clinical Documentation Operations Specialist

Hourly Pay Range:

Clinical Documentation Operations Specialist

The Clinical Documentation Operations Specialist is responsible for improving the overall quality and completeness of clinical documentation to ensure accurate coding appropriate reimbursement and compliance with regulatory requirements. This role involves working closely with physicians healthcare providers and coding staff to clarify and enhance the documentation of clinical information.

Position Highlights:

• Position: Clinical Documentation Operations Specialist

• Location: Hybrid Skokie IL and remote

• Full Time/Part Time: full-time (40 hours per week)

• Hours: Monday-Friday 8:00am-4:30pm

• Required Travel: required travel to other Endeavor Health locations for in person trainings and meetings

What you will do:

• Review medical records concurrently to ensure accuracy completeness and specificity of clinical documentation.

• Identify and clarify missing conflicting or nonspecific physicians documentation through queries and follow up.

• Collaborate with healthcare providers to ensure accurate and comprehensive documentation of patient diagnoses and treatments.

• Develop and implement effective query to resolve documentation issues.

• Ensure queries are clear concise and compliant with industrys standards and regulatory requirements.

• Track and follow up on outstanding queries to ensure timely responses.

• Query format and questions meet AHIMA and ACIDS guideline.

• Ensures adherence to professional standards quality standards licensure and federal laws.

• Ensure clinical documentation complies with all applicable regulations and standards including those set by CMS Joint Commission and other governing bodies.

• Provide education to the physicians and other clinical staff on documentation best practice and importance of accurate clinical documentation

• Attend education programs workshops and one-one-one training to enhance continuous learning.

• Participate in professional organization such as the Clinical Documentation Improvement Specialist (ACDIS) or the American Health Information Management.

• Actively engage in mentoring relationships to support less experienced colleagues and contribute to professional development within the team.

What you will need:

• Education: Associate in Nursing or HIM is required. Bachelors degree in nursing is preferred

• Certification: IL RN license strongly preferred. ADN or RHIT preferred

• Experience: 3-5 years RN experience in an Acute Care Hospital (critical care preferred)

• Unique or Preferred Skills:

  • Strong clinical knowledge and demonstrated commitment to maintaining relevancy in the clinical field.

  • Excellent analytical and communication skills.

  • Ability to work independently and collaboratively in a team environment.

  • Proficient in using electronic medical record (EMR) and clinical tools.

  • Familiarity with healthcare regulations including HIPAA and documentation standards

  • Proficient in using office software (e.g. Microsoft Office Suite excel) and other communication platforms (e.g. email video conferencing) for collaboration and reporting.

Benefits (For full time or part time positions):

• Opportunity for annual increases based on performance

• Career Pathways to Promote Professional Growth and Development

• Various Medical Dental Pet and Vision options

• Tuition Reimbursement

• Free Parking

• Wellness Program Savings Plan

• Health Savings Account Options

• Retirement Options with Company Match

• Paid Time Off and Holiday Pay

• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality vibrant community-connected care serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25000 team members and more than 6000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals Edward (Naperville) Elmhurst Evanston Glenbrook (Glenview) Highland Park Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) all recognized as Magnet hospitals for nursing excellence. For more information visit .

When you work for Endeavor Health you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website () to better understand how Endeavor Health delivers on its mission to help everyone in our communities be their best.

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

At Endeavor Health we are united by a shared commitment to working together to create a culture of connection and belongingeach of us bringing different skills and experiences as we deliver safe seamless and personal care. Every person every time. We are committed to fostering an environment where all team members can be their best learn and pursue excellence together.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets VEVRRA Federal Contractor.