Clinical/CDI Second Level Reviewer / Pre-Bill Auditor

Weingart Foundation; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare is seeking an experienced Clinical Second Level Reviewer / Pre-Bill Auditor to ensure precise documentation and coding practices that influence reimbursement and compliance. This role includes reviewing inpatient records, utilizing advanced technology, and collaborating with clinical teams to enhance accuracy before billing.

Qualifications

• 3+ years of CDI or coding experience focusing on inpatient care.
• Experience with second-level reviews in a hospital or health system.
• Strong knowledge of MS-DRG/AP-DRG and ICD-10 coding.

Responsibilities

• Conduct clinical validation reviews of inpatient records for accurate DRG assignment.
• Utilize Iodine tools to identify discrepancies in documentation.
• Collaborate with teams to resolve documentation discrepancies before claim submissions.

Skills

Analytical skills

Attention to detail

Communication

Education

RN or Coder certification

Tools

Iodine AwareCDI

Iodine AwareUM

Epic EHR

Job description

Overview:

Seeking experienced Clinical Second Level Reviewer / Pre-Bill Auditor to support accurate documentation and coding practices that impact reimbursement, quality metrics, and compliance. This role focuses on the pre-bill review of inpatient records, using clinical expertise and advanced technology platforms—including Iodine AwareCDI or AwareUM—to ensure accurate DRG assignment, appropriate clinical documentation, and defensible coding before final billing

Key Responsibilities

• Conduct clinical validation reviews of inpatient records pre-bill to ensure accurate and compliant DRG assignment.
• Utilize Iodine software tools to identify discrepancies and validate principal diagnoses, secondary diagnoses, procedures, and complications/comorbidities.
• Collaborate with CDI, HIM, and coding teams to resolve discrepancies and clarify documentation before claim submission.
• Escalate cases that require further review, physician query, or documentation improvement opportunities.
• Monitor trends, identify recurring issues, and support compliance and quality initiatives.
• Maintain thorough documentation of audit findings and recommendations in alignment with regulatory guidelines and facility policies.

• RN (preferred) or Coder (must have at least 3+ years of second-level review experience and conversing with CDI)
• 3+ years of CDI or coding experience with a strong focus on inpatient care.
• Experience conducting pre-bill or second-level reviews within a hospital or health system.
• Proficient in Iodine Software such as AwareCDI or AwareUM (preferred)
• Working knowledge of MS-DRG/AP-DRG, ICD-10-CM/PCS coding, and clinical guidelines.
• Familiarity with Epic or other major EHR platforms preferred.
• Strong analytical skills, attention to detail, and excellent communication abilities.