Clinical Documentation Specialist-Salem Hospital
Site: Mass General Brigham Incorporated
At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.
We are seeking a Clinical Documentation Integrity (CDI) Specialist who will play a pivotal role in improving the quality, completeness, and accuracy of clinical documentation. By working closely with medical teams, you'll ensure health records fully reflect the exceptional care provided, aligning with industry standards and supporting critical hospital reporting measures.
This is an exciting opportunity to make a meaningful impact on patient care and system-wide quality initiatives in a collaborative, inclusive environment.
Job Summary
This position combines clinical knowledge with collaboration, problem-solving, and a shared commitment to excellence. You'll be integral in shaping accurate documentation that influences outcomes, quality reporting, and overall healthcare delivery.
Responsibilities:
- Conduct concurrent reviews of clinical documentation to ensure accuracy and completeness.
- Collaborate with healthcare teams, including medical, nursing, and coding staff, to identify documentation improvement opportunities.
- Assign working DRGs based on industry-standard guidelines and ensure appropriate reflection of patient conditions.
- Facilitate clear, professional, and compliant communication with providers to address incomplete or inconsistent documentation.
- Use clinical expertise to validate findings and support clinically credible queries for diagnoses or procedures.
- Meet or exceed key performance indicators (KPIs) for CDI activities.
- Apply Mass General Brigham values to guide decisions and actions, promoting a collaborative and inclusive work environment.
Qualifications
Qualifications
- Licensure: Current RN license required.
- Experience: At least 5 years of acute medical/surgical nursing and at least 3 years of CDI experience is required.
- Certification: Clinical Documentation Improvement certification is preferred.
Additional Job Details (if applicable)
Additional Job Description
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
Apply Now
At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.
We are seeking a Clinical Documentation Integrity (CDI) Specialist who will play a pivotal role in improving the quality, completeness, and accuracy of clinical documentation. By working closely with medical teams, you'll ensure health records fully reflect the exceptional care provided, aligning with industry standards and supporting critical hospital reporting measures.
This is an exciting opportunity to make a meaningful impact on patient care and system-wide quality initiatives in a collaborative, inclusive environment.
Job Summary
This position combines clinical knowledge with collaboration, problem-solving, and a shared commitment to excellence. You'll be integral in shaping accurate documentation that influences outcomes, quality reporting, and overall healthcare delivery.
Responsibilities:
- Conduct concurrent reviews of clinical documentation to ensure accuracy and completeness.
- Collaborate with healthcare teams, including medical, nursing, and coding staff, to identify documentation improvement opportunities.
- Assign working DRGs based on industry-standard guidelines and ensure appropriate reflection of patient conditions.
- Facilitate clear, professional, and compliant communication with providers to address incomplete or inconsistent documentation.
- Use clinical expertise to validate findings and support clinically credible queries for diagnoses or procedures.
- Meet or exceed key performance indicators (KPIs) for CDI activities.
- Apply Mass General Brigham values to guide decisions and actions, promoting a collaborative and inclusive work environment.
Qualifications
Qualifications
- Licensure: Current RN license required.
- Experience: At least 5 years of acute medical/surgical nursing and at least 3 years of CDI experience is required.
- Certification: Clinical Documentation Improvement certification is preferred.
Additional Job Details (if applicable)
Additional Job Description
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
Apply Now