Outpatient Clinical Documentation Integrity Specialist

Description

Job Title: Outpatient Clinical Documentation Integrity Specialist

Job Description

Founded in 1991, IBJI is the largest orthopedic group practice in Illinois. With more than 150 physicians in every orthopedic specialty, IBJI offers care for adults and children from some of the most accomplished and respected orthopedists in the country. Serving northern Illinois and northwest Indiana with over 100 locations, IBJI makes it easy to access care. Our headquarters is in Park Ridge, Illinois, a northwest suburb of Chicago. 

Our clinical services include advanced MRI imaging, pain management, non-surgical and surgical treatment plans, rheumatology, physical therapy, occupational therapy, wellness, and sports training. Ortho Access walk-in clinics provide same day care for orthopedic injuries. Comprehensive care offered all in one place enables physicians, therapists and staff to work closely together, so that patients and families achieve better outcomes. Collaborative care is also more efficient. In many cases, IBJI services are substantially less expensive than those provided by large healthcare systems and emergency rooms.

Summary

The Outpatient Clinical Documentation Integrity (CDI) Specialist is responsible for improving the accuracy, completeness, and integrity of outpatient clinical documentation and coding across Illinois Bone & Joint Institute. This role performs prospective and retrospective audits, provides timely provider feedback and education, manages documentation and coding send-backs, and partners closely with coding, Revenue Cycle, and Epic teams to support compliant and accurate charge capture. The specialist also audits AI-assisted coding output, identifies documentation and revenue integrity opportunities, monitors trends, and supports workflow and system improvements that strengthen coding quality, reduce rework and denials, and ensure services are accurately represented and billed.

Responsibilities 

• Performs prospective and retrospective audits of outpatient clinical documentation, coding, and charge capture to validate accuracy, completeness, medical necessity, and compliance with applicable coding and payer requirements
• Reviews provider documentation and coded services for appropriate diagnosis, CPT, HCPCS,modifier, and E/M code selection and identifies opportunities for clarification or correction
• Provides clear, timely, and actionable feedback to physicians, advanced practice providers, coders, and operational teams regarding documentation and coding findings
• Develops and delivers provider education based on audit findings, coding trends, payer changes, regulatory guidance, and identified documentation opportunities
• Manages and monitors documentation and coding send-backs, including appropriate follow-up with providers and coders to support timely resolution and claim submission
• Partners with coding leadership and coding staff to review recurring coding questions, reconcile documentation and coding discrepancies, and promote consistent coding practices
• Coordinates with the Epic team on Revenue Cycle and CDI-related workflow, edit, workqueue, reporting, charge capture, and documentation enhancement opportunities; participates in testing and user acceptance testing (UAT) as needed
• Audits AI-assisted and automated coding output for accuracy, compliance, and consistency; identifies error patterns, documents findings, and collaborates with coding and technology teams on corrective actions and optimization
• Supports Revenue Integrity activities, including review of charge capture, missed or incorrect charges, coding edits, modifier use, billing rules, and workflow opportunities that may affect compliant reimbursement
• Identifies trends that may contribute to denials, claim edits, delayed billing, coding rework, or revenue leakage and partners with Revenue Cycle teams to develop sustainable solutions
• Assists with the development and maintenance of coding, CDI, and Revenue Integrity policies, procedures, tip sheets, education materials, and standardized workflows
• Tracks and reports audit results, provider education activity, send-back volumes, error trends, and improvement opportunities; escalates significant or recurring findings to leadership
• Participates in Revenue Cycle change control, Epic optimization, and process improvement initiatives that impact coding, documentation, charge capture, and claims
• Maintains current knowledge of ICD-10-CM, CPT, HCPCS, NCCI edits, payer policies, Medicare requirements, and other applicable coding and billing guidance
• Maintains confidentiality of patient information in accordance with HIPAA and organizational policies
• Supports departmental goals, quality initiatives, and other Revenue Cycle responsibilities as assigned
• Maintain a clean and safe work environment
• Other duties as assigned

Requirements

Requirements

Education

• Associate degree in Health Information Management, Health Information Technology, Nursing, or a related healthcare field preferred; equivalent relevant experience may be considered

Certifications/Licensure

• Current professional coding credential such as CPC, CCS, CCS-P, or equivalent strongly preferred
• CPMA, CDIP, CCDS-O, or other auditing/CDI credential preferred

Experience

• Minimum of three years of professional fee outpatient coding, coding auditing, CDI, or Revenue Integrity experience preferred
• Orthopedic, musculoskeletal, or multi-specialty physician practice experience strongly preferred
• Experience providing physician/provider education and communicating audit findings preferred
• Experience with Epic, including professional billing workflows, workqueues, edits, or reporting, preferred
• Experience reviewing computer-assisted coding, autonomous coding, or AI-supported coding solutions preferred

Technical Skills

• Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, E/M coding, NCCI edits, and professional fee coding guidelines
• Ability to interpret clinical documentation, payer policies, and coding guidance and apply them consistently to outpatient services
• Strong analytical skills with the ability to identify trends, root causes, and revenue cycle improvement opportunities
• Proficiency with electronic health records, coding systems, Microsoft Office applications, and data/reporting tools

Soft Skills

• Excellent verbal and written communication skills with the ability to provide constructive, credible feedback to providers and staff
• Ability to educate and influence through collaboration while maintaining a compliance-focused approach
• Highly detail-oriented with strong organization, follow-up, and prioritization skills
• Ability to work independently while partnering effectively across Coding, Revenue Cycle, Epic/IT, clinical operations, and provider leadership
• Demonstrates sound judgment, professionalism, curiosity, and a continuous improvement mindset

Physical Requirements

• Requires prolonged periods of sitting and computer use
• Frequent use of keyboard, mouse, telephone, and other standard office equipment
• Ability to work effectively in a fast-paced healthcare office environment and manage multiple priorities

This description is intended to provide only basic guidelines for meeting job requirements. Duties and responsibilities, experience, qualifications, skills, supervisory relationship, physical/mental demands, and environmental/ working conditions may change as needs evolve.

Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week): medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.

Illinois Bone and Joint Institute, LLC is an equal opportunity employer. All employment decisions are based on qualifications, merit, and business need, without regard to race, color, religion, age, sex, national origin, disability status, military or veteran status, sexual orientation, gender identity and expression, or any other characteristic protected by federal, state or local laws. This policy applies to recruitment and placement, promotion, training, transfer, retention, rate of pay and all other terms and conditions of employment.