Clinical Documentation Specialist Resume Sample

Clinical documentation specialists ensure forms are adequately filled out with all compliance guidelines met. Duties include reviewing all patient documentation, preparing written reports, graphing statistics, reaching out to people for additional information, administrative tasks, and training others to identify gaps.

For many, writing a resume can be daunting. If you are working on your own, it is easy to become overwhelmed with the amount of information you need to include and how best to present yourself.

The sample resumes below provide great examples of how to write an effective resume.

The Best Clinical Documentation Specialist Resume Samples

These are some examples of accomplishments we have handpicked from real Clinical Documentation Specialist resumes for your reference.

Clinical Documentation Specialist Resume Sample 1

  • Entered data with 100% accuracy despite competing demands.
  • Followed established procedures with no errors in daily transcription of physician order for patient treatment.
  • Reduced the number of billing discrepancies from 4% to 0.5%, and increased the percentage of revenue collected by 9%.
  • Handled insurance claims and managed accounts receivable; effectively educated patients on payment plans and terms.
  • Maintained up-to-date records on all policy changes preserving company’s financial status; effectively managed multiple tasks simultaneously without compromising quality or quantity, resulting in an increase 25% of productivity levels within 2 months.

Clinical Documentation Specialist Resume Sample 2

  • Completed the New Patient Orientation course.
  • Complemented physicians’ work during day or evening office hours by providing clinical information or support for patient care.
  • Provided documentation to support diagnostic procedures, medications, and expected outcomes of treatment.
  • Received satisfactory customer feedback on interactions via phone and email; effectively resolved concerns related to account requests in a timely manner.
  • Paraphrased physician evaluations into concise, legible narratives that can easily be accessed by nurses and insurance companies.

Clinical Documentation Specialist Resume Sample 3

  • Performed a variety of administrative tasks related to documentation, coding, and abstracting.
  • Provided up-to-date reports for physicians with extensive coverage during busy periods or when away from the office via e-mailed records, documents, faxes.
  • Reduced call volume by 20% through increased departmental efficiency by implementing workflow changes resulting in more efficient charge capture process.
  • Transcribed over 100 hours of physician dictation accurately without error or revision per editing metrics.
  • Received an award recognizing outstanding customer service to internal customers during performance improvement team project review.

Clinical Documentation Specialist Resume Sample 4

  • Performed evaluations of clinical documentation with physicians, nurses, and other health care professionals to determine level of care.
  • Received outstanding performance award for resolving a backlog situation within a week while maintaining quality service levels.
  • Managed patient record requests by coordinating the release of information to the appropriate individuals or entities in compliance with state and federal regulations.
  • Exceeded personal goals by processing 30% more medical records than targeted goal while reducing error rates from 9 to 3%.
  • Pioneered development of unique system that expedited patient record requests by 75% while increasing customer satisfaction ratings from 98% positive to 100% positive.

Clinical Documentation Specialist Resume Sample 5

  • Performed all tasks related to processing requests for clinical documentation.
  • Achieved certification in working with the CDI department, one of only two employees to complete this training at hospital.
  • Successfully completed medical terminology course within 3 months of hire.
  • Received awards for regular attendance and leading team at morning huddles three months in a row.
  • Developed methods to meet the urgent demands of internal customers by locating records more quickly, effectively updating information technology systems regarding new clinical procedures being tested on patients or new medications being administered.

Clinical Documentation Specialist Resume Sample 6

  • Expedited clinical documentation from physician office dictations with a focus on patient safety and quality of care, leading to improved reimbursements.
  • Devised a solution to an error in the ICD-10 coding process by consulting with physicians for correcting diagnosis codes.
  • Promoted twice during tenure at Cleveland Clinic, currently holding senior position. Verified that all health care documentation was legible, complete, and concurrent with state and federal compliance regulations.
  • Conducted medical necessity audits using evaluation tools such as MDS 3.0 with tracking ability, GEMS worklists with five years of auditing history, and RADV reports from DMR system with nine of data entry experience.
  • Awarded Signature Club and recognition for consistently surpassing bonus and productivity expectations.

Clinical Documentation Specialist Resume Sample 7

  • Diagnosed and accurately classified patient conditions.
  • Completed all documentation in a timely manner.
  • Performed complex review functions to ensure proper coding, billing, and compliance with federal healthcare program requirements.
  • Organized daily reports to assist department managers in evaluating staff productivity and patient care management.
  • Improved customer service by establishing new policies that increased the accuracy of electronic data transfers resulting in higher quality reports and less turnaround time for documents.

Clinical Documentation Specialist Resume Sample 8

  • Efficiently managed time working 6-minute modules within a 6 hour shift change.
  • Conducted nursing case audits analyzing patient data in order to identify opportunities for medical necessity and compliance with governmental regulations.
  • Effectively resolved customer complaints by developing procedures that increased the accuracy of information, safeguarding the integrity of medical records, and positively impacting reimbursement from third party payers through accurate documentation.
  • Recognized as a team player after successfully managing multiple documentation projects including emergency department forms revision and electronic health record implementation.
  • Managed a team of six contractors who completed over 100 charts per day during peak census times. This project reduced chart backlogs from four days to less than one day.

Clinical Documentation Specialist Resume Sample 9

  • Conducted light typing; accurately transferred numerical data into spreadsheets, databases, and design forms.
  • Oversaw all documents for an entire department to ensure compliance with HIPAA patient confidentiality standards.
  • Recognized as the team player of the month for organizing daily business documentation tasks and effortlessly assisting all staff members.
  • Reviewed paperwork related to time studies and determined a method of error-proofing that increased productivity by 25%.
  • Selected as a customer service representative because of excellent speed, accuracy, and detail when responding to requests from doctors’ offices regarding insurance payment verification needs.

Clinical Documentation Specialist Resume Sample 10

  • Documented a total of 3,074 medical records for patients with respiratory ailments over the course of one year.
  • Established and maintained business relationships with physicians, other clinical documentation specialists, and clerical staff to ensure smooth workflow.
  • Trained ten new hires on coding procedures during their first week on the job; providing them with essential knowledge needed to succeed in positions under my supervision.
  • Acknowledged for continuing commitment to patient confidentiality after consistently adhering to HIPPA policies while interacting with clients and co-workers.
  • Recognized by management for outstanding performance in a fast-paced work environment after generating a 44% return on investment for clinic through accurate reimbursement submissions.

Clinical Documentation Specialist Resume Sample 11

  • Exhibits knowledge of appropriate coding and documentation practices. Identify appropriate encounter type.
  • Ensures compliance with established medical necessity criteria, as well as clinical and financial reimbursement requirements by calling on providers/facilities for clarification as necessary.
  • Collects accurate data from physicians to assist in case management services. Monitor patient care costs to provide assistance in cost containment initiatives through more efficient utilization of MSP resources.
  • Recovered $14,000 annually following a dispute over a previously paid claim due to the professional services of a legal advocate who appealed an incorrect payment decision made by Medicare review contractors on behalf of CMS which resulted in a reversal of the initial.
  • Delivered administrative support to the St. Vincent Education Center for three years, maintaining an organized filing system of all incoming patient notes.

Wrap Up

To work as a clinical documentation specialist, you must have at minimum an associate degree in fields related to health information technology, with the option to earn AHIMA’s Registered Health Information Technician credentials. Clinical documentation specialists must demonstrate skills in communication, organization, high attention to detail, data analysis, problem-solving, adaptability and basic computer competency.

Resumes are a crucial aspect of any job search. In order to make a good first impression, it is important that your resume be formatted and written professionally. To create the perfect resume, think about what skills and qualities you want your future employer to see.

Hope these samples gave you an idea of what your resume should look like and some tips on how to make sure that your resume stands out from the rest.


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