Lead Clinical Documentation Integrity Specialist

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. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE.

The Lead Clinical Documentation Integrity (CDI) Specialist oversees the eleHealth/Care Delivery CDI Program and ensures accurate, complete, and compliant clinical documentation across participating practices. This role provides leadership to CDI Specialists, partners with providers and clinical staff, and drives strategic initiatives to improve documentation quality, regulatory compliance, and performance in value‑based programs.

How You Contribute to the Company’s Mission In This Role

• Lead and oversee the Clinical Documentation Integrity program across participating practices, ensuring consistency, accuracy, and compliance.
• Provide leadership, guidance, and support to CDI Specialists, including education, coaching, and performance oversight.
• Develop and implement standardized CDI processes, job aids, and error‑prevention tools to optimize documentation workflows and EMR utilization.
• Educate providers and clinical staff on best practices for clinical documentation, coding accuracy, and risk adjustment.
• Conduct prospective and retrospective documentation reviews; analyze data to identify trends, gaps, and improvement opportunities.
• Collaborate with physicians, coders, population health, and practice leadership to support quality programs and value‑based care initiatives.
• Ensure compliance with applicable federal, state, and regulatory requirements related to Medicare coding and documentation.
• Lead CDI‑related projects and initiatives aligned with organizational goals and population health strategies.
• Gather provider feedback to continuously improve educational content and delivery methods.

Required Qualifications

• Bachelor’s degree in a related field.
• Minimum of 7 years experience in Clinical Documentation Integrity (CDI), coding, or clinical documentation.
• At least 3 years of experience supporting healthcare value-based programs, including Medicare Risk (experience may run concurrently)
• At least one active coding certification required (CPC, CRC, CCS‑P, CCS‑H, RHIT, CCDS, or CDIP).
• Advanced knowledge of ICD‑10 guidelines, clinical documentation standards, and diagnostic coding.
• Knowledge of CMS quality programs, HCCs, value‑based care models, and EHR systems.
• Strong analytical, critical thinking, problem‑solving, and communication skills.
• Proficiency in Microsoft Office (Excel, Word, PowerPoint, Outlook).
• Ability to manage multiple priorities, meet deadlines, and work independently.
• Ability to travel up to 30% to participating practice offices.

Preferred Qualifications

• Master’s degree in Nursing, APRN, or Information Management (MIM).
• Experience managing remote or hybrid teams.
• Experience working in lean or startup‑style healthcare environments.
• Demonstrated experience leading cross‑functional initiatives and provider education programs.

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.