The Clinical Documentation Improvement (CDI) Specialist – Professional Billing supports accurate, compliant professional fee billing through focused review and improvement of provider documentation.
This role partners closely with physicians, advanced practice providers (APPs), professional coders, and revenue cycle stakeholders to ensure documentation fully supports CPT, HCPCS, ICD-10-CM codes, modifier usage, and medical necessity.
The CDI Specialist serves as a documentation and coding subject matter expert, emphasizing education, collaboration, and prevention of downstream denials or compliance risk rather than claim production volume.
Job duties
- Review outpatient, clinic, procedural, and surgical professional documentation to identify gaps impacting coding accuracy and compliance.
- Ensure documentation supports E/M level selection, procedure complexity, modifier use, and payer medical necessity requirements.
- Identify documentation trends that may result in down coding, denials, or audit exposure.
- Initiate compliant provider queries to clarify diagnoses, procedures, clinical intent, and E/M components.
- Provide case-based and trend-based education to physicians and APPs focused on professional documentation best practices.
- Serve as a trusted advisor to providers regarding documentation requirements for professional billing.
- Collaborate with professional coders to ensure documentation supports accurate CPT, HCPCS, ICD-10-CM, and modifier assignment prior to claim submission.
- Partner with revenue integrity, denials, and compliance teams to resolve documentation-related issues.
- Support initiatives to improve first-pass yield and reduce rework and payer recoupments.
- Support internal and external audits by validating documentation support for billed professional services.
- Track and trend documentation issues, provider response rates, and improvement opportunities.
- Participate in continuous improvement initiatives related to documentation standards and professional billing workflows.
Minimum qualifications
- High school diploma or GED.
- Four years of relevant experience.
- One of the following certifications: CPC, CIC, CCS-P, RHIA, or RHIT.
Preferred qualifications
- Experience in professional fee CDI, professional coding, auditing, or revenue integrity.
- Clinical background such as RN, LPN, MA, or allied health.
- Experience in a multispecialty or academic practice plan.
- Familiarity with payer policies, NCCI edits, and modifier-driven denials.
- CDI certification.
Additional requirement
- Must be legally authorized to work in the United States; no visa sponsorship is available.
Location
Houston, Texas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
4 weeks ago