Clinical Documentation Specialist

This job is with Blue Health

The Clinical Documentation Specialist (CDS) plays a vital role in supporting the prior authorization (PA) process by ensuring that all medical documentation is accurate, complete, and compliant with payer requirements. The CDS collaborates closely with providers, clinical staff, and the prior authorization team to streamline submission workflows and reduce delays in care delivery.

Key Responsibilities

Review clinical notes, medical records, and encounter documentation to ensure completeness and accuracy for prior authorization submissions.

Identify missing or incomplete information and work directly with providers or clinical teams to obtain required documentation.

Prepare and organize chart notes, supporting materials, and cover sheets in accordance with payer-specific requirements.

Assist in drafting clear and concise medical necessity summaries aligned with current clinical guidelines and payer criteria.

Monitor prior authorization requests to ensure timely follow-up and resolution of denials or additional information requests.

Maintain thorough and accurate documentation within the electronic health record (EHR) and prior authorization platforms.

Collaborate with the billing, utilization management, and compliance teams to ensure documentation integrity and adherence to standards.

Stay current on payer policies, documentation standards, and regulatory updates related to prior authorization and medical necessity.

Qualifications

Education: D-Pharmacy, Associate or Bachelors degree in allied health sciences, Nursing, Health Information Management, or related healthcare field preferred.

Experience: Minimum of 1 year in medical documentation, utilization review, or prior authorization coordination.

Skills:

Strong understanding of payer guidelines and medical necessity criteria.

Proficiency with EHR systems and prior authorization software.

Excellent written and verbal communication skills.

Detail-oriented with strong organizational and analytical abilities.

Ability to collaborate effectively in a fast-paced environment.

Preferred Experience

Working knowledge of clinical documentation principles.

Prior experience supporting specialty medications, DME, or outpatient services authorizations.

Familiarity with payer portals and insurance workflows.

Core Competencies

Clinical accuracy and compliance awareness

Timeliness and workflow efficiency

Interdepartmental collaboration

Quality assurance and data integrity

Adaptability to payer-specific documentation requirements