Clinical Documentation Integrity (CDI) Specialist - Remote

Guidehouse Inc.; United States; Remoto; USD 68.000 - 113.000; Tempo pieno

Descrizione del lavoro

Guidehouse is seeking a Clinical Documentation Integrity Specialist to review health records and collaborate with providers and coding teams to improve documentation quality and reimbursement accuracy. This role focuses on identifying opportunities to clarify diagnoses and procedures and generating compliant queries per industry guidelines.

The candidate will work with CDI software and EHR systems, ensuring adherence to official coding guidelines and DRG principles while maintaining productivity

Competenze

• Bachelor's degree required or equivalent experience.
• RN, MD or MD Equivalent, RHIA, RHIT, CCS with license preferred.
• 2+ years acute care inpatient hospital coding or CDI experience.
• Familiarity with encoder and DRG assignment.
• Maintain knowledge of official coding guidelines and coding clinics.

Mansioni

• Reviews medical records to identify CDI opportunities.
• Collaborates with providers and coding team to ensure accurate documentation for appropriate reimbursement and clinical detail.
• Prepares compliant physician queries following ACDIS/AHIMA guidelines.
• Identifies principal and secondary diagnoses and significant procedures to assign working MS-DRG.
• Updates DRG based on documentation during reviews to reflect expected LOS and SOI/ROM.

Conoscenze

CDI experience

DRG assignment

Encoder familiarity

Medical terminology

Formazione

Bachelor's degree

Strumenti

CDI software

EHR systems

Encoders

Descrizione del lavoro

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
• Ability 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 benefi