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Registered Nurse, Clinical Documentation Specialist – CDIP, CCDS

Remote, USA Full-time Posted 2026-06-23

Job Description:

  • Improving the overall quality and completeness of clinical documentation
  • Modifying clinical documentation through interaction with Physicians, Nursing staff, other patient caregivers, and medical records coding staff
  • Ensuring appropriate reimbursement is received for services rendered
  • Educating all members of the patient care team on clinical documentation
  • Conducting admission/continued stay reviews using the Compliant Documentation Program Management (CDMP) guidelines
  • Monitoring documentation against "core measure" quality indicators and addressing non-compliance documentation
  • Collaborating with coding staff to assign the "working" DRG to contribute for IDT Rounds
  • Maintaining a leadership role to ensure compliant documentation
  • Organizing and performing work effectively and efficiently

Requirements:

  • Current RN Licensure in the State of Georgia
  • Associates Degree
  • Minimum of five (5) years in the practice of professional nursing
  • CCDS or CDIP certifications preferred
  • Bachelor's Degree in Nursing preferred
  • Additional education in Finance, Healthcare regulations, and diagnoses-procedure coding preferred
  • Experience in Healthcare Utilization and Revenue Management preferred
  • Working knowledge of DRG coding optimization strategies and clinical documentation requirements
  • Familiar with ICD10 coding conventions, anatomy and physiology, medical terminology, MSDRG reimbursement, coding software
  • Excellent analytical thinking, problem-solving abilities, and written and verbal communication skills

Benefits:

  • Health insurance
  • 401(k) matching
  • Paid time off
  • Flexible work hours
  • Professional development opportunities

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