The Clinical Documentation Integrity (CDI) Specialist is accountable for reviewing patient medical records in the inpatient and/or outpatient setting to capture accurate representation of the severity of illness and facilitate proper coding. The CDI Specialist validates that coding reflects medical necessity of services and facilitates appropriate coding which provides an accurate reflection and reporting of the severity of the patient's illness along with expected risk of mortality and complexity of care. Documentation of discharge diagnoses and co-morbidities are a complete reflection of the patient's clinical status and care. Utilizes advanced knowledge of disease processes (pathophysiology), medications, and have critical thinking skills to analyze current documentation to identify gaps. Identifies opportunities in concurrent and retrospective inpatient clinical medical documentation to support quality and effective coding. Understands and applies regulatory compliance related to documentation, coding and billing for all health insurance plans. The CDI Specialist facilitates appropriate modifications to documentation through extensive interactions and collaboration with physicians, coding, case management, nursing and other care givers. Serves as an effective change agent as an educator and resource for physicians and allied health staff to improve the quality and completeness of the clinical documentation. Performs all duties and responsibilities in accordance with ethical and legal business procedures, compliant with federal and state statutes and regulations, official coding rules, guidelines and accepted standards of coding practice including appropriate clinical documentation policies.
• Demonstrates and applies in-depth knowledge of the conventions, rules, and guidelines of multiple classification systems, including ICD-10, diagnosis and procedures, and Current Procedural Terminology (CPT).
• Demonstrates and applies in-depth knowledge of disease process in multiple medical / surgical specialties.
• Completes initial concurrent reviews of patient records for specified patient populations to evaluate documentation, to assign working DRG, pertinent secondary diagnoses and procedures for accurate APR-DRG assignment, risk of mortality and severity of illness.
• Partners with coding professionals to ensure accuracy of diagnostic and procedure data and completeness of supporting documentation to determine appropriate APR-DRG assignment.
• Queries physicians regarding missing, unclear or conflicting health record documentation.
• Provides ongoing education and support to the CDI Specialists regarding clinical indicators and criteria.
• At least 3 to 5 years inpatient CDI review experience
• At least 7 years of related experience is preferred.
• Four-year Bachelor's degree or equivalent experience is required BSN or RHIA
• Graduate or professional work or advanced degree; or equivalent experience is preferred
Licenses & Certifications:
• CCDS or CDIP required
• CRC or CCS is preferred but not required
- Salary Range: $93,000 to 104,000 per year
- Paid Time Off
- Sick Time
- Medical, Dental, Life and Long/Short term disability Insurance.
- Paid Association Dues Paid
- Educational Benefits
Revenue Cycle Solutions formerly MedPartners and Peak and Peak offers opportunities for learning and career development; competitive pay; and a comprehensive benefits program. We promote a diverse and inclusive workplace. Our team members have a voice in their work through surveys, pulses and town halls.