[Hiring] Senior Clinical Documentation Integrity Specialist @Blue Cross and Blue Shield of Louisiana

Role Description

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.

• 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.

Qualifications

• Bachelor’s degree in a related field.
• 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.

Requirements

• Master’s degree in Nursing, Advanced Practice Registered Nurse (APRN), or Information Management Professional (MIM) (preferred).
• Advanced knowledge of preventive health standards and clinical standards of care (preferred).
• Experience collaborating with population health teams and multi‑disciplinary clinical stakeholders (preferred).

Benefits

• 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.
• Work environment that will optimize personal health and well-being.
• Smoke and tobacco-free company properties.