Overview
Document Review Specialist Jobs in United States at Community Health Systems
Title: Document Review Specialist
Company: Community Health Systems
Location: United States
Job Summary
The Documentation Review Specialist conducts quality audits and reviews of medical records to ensure accurate coding and billing practices for professional services. This role verifies that provider documentation supports submitted codes and meets payer and regulatory standards. The Specialist partners with internal stakeholders to identify compliance risks, deliver education, and promote consistent documentation practices across the organization.
Essential Functions
Audits medical records to validate the accuracy of CPT, HCPCS, ICD-10, and HCC coding for professional services, including evaluation and management, procedural, and ancillary services.
Confirms medical record documentation meets required standards, including signatures, attestations, authorizations, ABNs, and consents, to support billing compliance.
Prepares clear, detailed audit reports using designated audit management tools, documenting findings and identifying trends or issues.
Collaborates with Compliance and Physician Practice leaders to share audit results and assist in developing targeted provider and staff education.
Serves as a subject matter resource on coding guidelines, billing regulations, and documentation standards.
Maintains up-to-date knowledge of payer rules, CMS regulations, and National and Local Coverage Determinations (NCDs and LCDs).
Participates in quality assurance by submitting bi-annual samples of audit work and maintaining an accuracy rate of 95% or higher.
Assists in the creation and maintenance of educational materials and documentation tools to support compliance.
Supports special projects as assigned in alignment with organizational compliance initiatives.
Ensures confidentiality and secure handling of provider, patient, and billing information in accordance with HIPAA and organizational policies.
Performs other duties as assigned.
Complies with all policies and standards.
Qualifications
H.S. Diploma or GED required
Associate Degree in Health Information Management, Healthcare Administration, Nursing, or a related field preferred
3-5 years of experience in professional coding, auditing, or clinical documentation review required
Experience working in a healthcare compliance, billing, or revenue cycle role preferred
Knowledge, Skills And Abilities
Knowledge of current CPT, HCPCS, ICD-10, and HCC coding guidelines and billing regulations.
Familiarity with Medicare, Medicaid, and commercial payer documentation and reimbursement requirements.
Strong analytical, auditing, and documentation review skills with a high attention to detail.
Excellent written and verbal communication skills with the ability to clearly explain findings and recommendations.
Proficiency with Microsoft Office and audit management or electronic health record (EHR) systems.
Licenses and Certifications
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification required
Additional compliance or auditing certifications (e.g., CPMA, CDEO) preferred
