Clinical Documentation Specialist
Compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the healthcare system. Classify medical and healthcare concepts, including diagnosis, procedures, medical services, and equipment, into the healthcare industry's numerical coding system. Includes medical coders.
At a Glance
Clinical Documentation Specialist. Typical education: Bachelor's degree. Experience: 3.8–4.2 years. Top skills: Operations, Microsoft Excel, Clinical Documentation Improvement.
Not available
Bachelor's degree
3.8–4.2 years
6
Parent Occupation (O*NET)
Medical Records Specialists
Median Wage
$50,250/yr
Growth (2024-34)
+7.1%
Education
Postsecondary nondegree award
Skills & Requirements
Specialized Skills (17)
Clinical Documentation Improvement
Utilization Management
Case Management
Managed Care
Diagnosis-Related Group
Revenue Cycle Management
Medicaid
Effective Communication
Data Analysis
Revenue Management
Management Consulting
Business Process
Business Negotiation
Anesthesiology
Medical Terminology
Clinical Documentation
Critical Care
Common Skills (9)
Operations
Problem Solving
Creative Problem Solving
Presentations
Leadership
Management
Consulting
Certifications (4)
Registered Health Information Technician (RHIT)
Registered Health Information Administrator (RHIA)
Certified Coding Specialist (CCS)
Certified Documentation Improvement Practitioner (CDIP)
Related Specializations
Other specialized occupations in this field. Many share overlapping skills, making lateral moves more accessible.
Related Pages
Frequently Asked Questions
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