Senior Clinical Documentation Integrity Specialist

Requirements

• Master's degree in Nursing, Advanced Practice Registered Nurse (APRN), or Information Management Professional (MIM)
• Advanced knowledge of preventive health standards and clinical standards of care
• Experience collaborating with population health teams and multi‑disciplinary clinical stakeholders
• The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.
• An Equal Opportunity Employer
• All internal employees please apply through Workday Careers.
• PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
• Additional Information
• If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

Benefits

Additional Information

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us. Residency in or relocation to Louisiana is preferred for all positions. POSITION PURPOSE . The Senior Clinical Documentation Integrity Specialist ensures accurate, complete, and compliant clinical documentation that appropriately reflects severity of illness, risk of mortality, and supports correct reimbursement. This role partners closely with providers, coding teams, and practice participants to drive documentation quality, regulatory compliance, and value-based care initiatives. How You Contribute to the Company's Mission In This Role Develops and implements standard processes, job aids, and error prevention tools to strengthen clinical documentation integrity across participating practices. Educates providers and office staff on best-practice clinical documentation standards to ensure accuracy, completeness, and compliance. Conducts prospective and retrospective reviews and prepares analyses and reports to identify trends, gaps, and improvement opportunities. Provides guidance and consultation to internal practice staff to improve coding proficiency and documentation accuracy. Collaborates with population health and practice teams to support quality programs, value-based initiatives, and standardized data abstraction processes. Advises practice staff on compliance with applicable federal, state, and local regulations related to Medicare coding and documentation guidelines. Required Qualifications Bachelor's degree in a related field (4 years of related experience can be used in lieu of degree) Minimum of 5 years of experience in Clinical Documentation Integrity (CDI) or coding At least 3 years of experience supporting healthcare value-based programs, including Medicare Risk (experience may run concurrently) At least one required certification, such as CPC, CRC, CCS‑P, CCS‑H, RHIT, CCDS, or CDIP Advanced knowledge of ICD‑10 coding guidelines and clinical documentation standards Strong understanding of CMS quality programs, HCCs, value‑based care models, and EHR systems Excellent written, verbal, interpersonal, and presentation skills Advanced proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook) Strong critical thinking, problem‑solving, and time‑management skills

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