Clinical Documentation Integrity (CDI) Specialist - Remote

US104 Guidehouse Managed Services LLC; Birmingham (AL); Hybrid; USD 68,000 - 113,000; Full time

Benefits offered by this job

Health insurance

Holidays and paid time off

Discretionary incentive bonus

Parental Leave

401(k) Retirement Plan

Life insurance

Health Savings Account

Flexible Spending Accounts

Short-Term & Long-Term Disability

Tuition Reimbursement

Job summary

Guidehouse seeks a Clinical Documentation Integrity Specialist to review health records, clarify documentation, and ensure compliant reimbursement. You will work with providers, coding teams, and CDI software to capture accurate diagnoses, MS-DRG assignments, SOI and ROM.

Requires bachelor’s degree and 2+ years CDI or inpatient coding experience; familiarity with encoder tools and DRG assignment is preferred. Travel not required; competitive benefits offered.

Qualifications

• Bachelor’s degree required; relevant experience may substitute.
• RN, MD or MD Equivalent, RHIA, RHIT, CCS with active license preferred.
• 2+ years acute care inpatient hospital coding or CDI experience required.

Responsibilities

• Conducts concurrent reviews of medical records to identify documentation needs.
• Identifies opportunities to clarify documentation and validate diagnoses.
• Prepares compliant physician queries following ACDIS/AHIMA guidelines.
• Assists in assigning MS-DRG, SOI and ROM based on record documentation.
• Tracks physician query responses and maintains productivity and quality benchmarks.
• Collaborates with Coding team on ICD-10 coding and DRG assignment.

Skills

Clinical documentation

Query writing

HIPAA compliance

Education

Bachelor’s degree

RN/MD or equivalent (RHIA/RHIT/CCS)

Tools

Encoder software

DRG systems

Job description

Job Family: CDI Specialist Travel Required: None Clearance Required: None

What You Will Do:

The Clinical Documentation Integrity Specialist reviews and analyzes health records to identify opportunities to clarify relevant diagnoses and procedures for distinct patient encounters. Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes, and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.

Duties and Responsibilities:

• Conducts comprehensive initial and follow-up concurrent reviews of medical records for assigned patients in the time frame, frequency and prioritization as defined for the CDI team
• Identifies opportunities to clarify incomplete or conflicting documentation and/or to validate diagnosis in the medical record.
• Understands the guiding principles of clinical validation and writing a compliant query
• Prepares a compliant written query for responsible treating physician, following the most current ACDIS/AHMIA Guidelines to Achieving a Compliant Query Process
• Identifies principal diagnosis options, secondary diagnoses and significant procedures in order to assign working MS-DRG.
• Establishes a working DRG and updates DRG based on record documentation during concurrent reviews to reflect current expected Length of Stay as appropriate
• Utilizes the appropriate UAB query template and follows 2022 ACDIS/AHIMA Guidelines to Achieving a Compliant Query Process
• Ensures relevant and/or approved clinical indicators specific to the patient and the clinical record are cited on the query template.
• Choices provided on the query must reflect reasonable conclusions specific to the patient and the clinical record Demonstrates knowledge of Patient Safety Indicator’s (PSI’s), Hospital Acquired Conditions (HAC’s), Severity of Illness & Risk of Mortality (SOI/ROM) as well as present on admission status
• Able to appropriately apply and use hospital approved clinical indicators for specified diagnoses
• Ability to follow hospital specific procedures and policies with regards to documentation requirements, query escalation, DRG reconciliation and other duties.
• Tracks physician query response documented in the medical record
• Maintains productivity and established performance benchmarks for quality
• Ensures competency in use of CDI application to process and prioritize daily work lists, capture results of record reviews, track queries and query responses.
• Enters all required data into CDI application and/or other systems to enable coders and CDI/Coding auditors to determine disposition of concurrent queries in order to assign the final MS-DRG as well as SOI and ROM
• Ensures competency in use of electronic coding references to code and assign working MS-DRG along with, SOI and ROM; as well as reference related Official Coding Guidelines and Coding Clinic for accurate code assignment
• Collaborates with Coding team on any questions related to ICD-10 coding and/or MS-DRG assignment, involved in the preparation of concurrent and/or retrospective queries.
• Participates in DRG reconciliation process in a collaborative, timely, and thorough manner with coders
• Participates in departmental and hospital committees, assigned task forces, including service line assignment meetings as requested
• Contributes to a positive and collaborative working environment
• Comply with HIPAA and code of conduct policies

What You Will Need:

• Bachelor’s degree (Relevant experience may be substituted for formal education or advanced degree)
• At least one of the following: RN, MD or MD Equivalent, RHIA, RHIT, CCS, with a current/active license
• 2 + years acute care inpatient hospital coding or CDI experience
• Familiarity with encoder and DRG assignment
• Maintain current working knowledge of official coding guidelines and coding clinics

What Would Be Nice to Have:

• CCDS or CDIP certification
• Strong clinical understanding of disease process.
• Demonstrate critical thinking, analytical skills, and ability to resolve problems.
• Strong knowledge of medical terminology, anatomy, physiology, microbiology, and disease processes
• Excellent communication skills, employing tact and effectiveness.
• Ability to converse with physicians in sometimes difficult scenarios.
• Strong typing and computer skills; proficiency with EHR systems, CDI software systems and encoders

The annual salary range for this position is $68,000.00-$113,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account
• Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [e-mail]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.

Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future. guidehouse.com