Clinical Documentation Integrity (CDI) Specialist - Remote

Guidehouse; Washington (District of Columbia); Remote; USD 68,000 - 113,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid Holidays

401(k) Plan

Health Savings Account

Tuition Reimbursement

Employee Referral Program

Emergency Back-Up Childcare

Job summary

Guidehouse seeks a Clinical Documentation Integrity Specialist to review health records, clarify diagnoses, and ensure compliant reimbursement. You will work with providers and the coding team to optimize MS-DRG, SOI/ROM and PSI indicators while maintaining HIPAA compliance.

Required: Bachelor's degree and 2+ years of acute care CDI or coding experience, with strong communication and analytical skills and knowledge of ICD-10 guidelines.

Qualifications

• Bachelor’s degree required; clinical or coding credentials preferred.
• 2+ years acute care inpatient hospital coding or CDI experience.
• Familiarity with ICD-10 coding guidelines and MS-DRG concepts.
• Understanding of HIPAA, coding clinics and query processes.

Responsibilities

• Review medical records and identify opportunities to clarify diagnoses and procedures.
• Prepare compliant physician queries following ACDIS guidelines.
• Assign working MS-DRGs and reflect accurate LOS and SOI/ROM.
• Collaborate with coding team, physicians and CDI software tools.

Skills

Communication skills

Critical thinking

Analytical skills

Problem solving

Medical terminology

Education

Bachelor’s degree

RN license

MD or MD Equivalent

RHIA

RHIT

CCS

Tools

Encoder

CDI software systems

EHR systems

Encoders

Job description

Job Family:CDI SpecialistTravel Required:NoneClearance Required:NoneWhat 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 teamIdentifies 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 queryPrepares a compliant written query for responsible treating physician, following the most current ACDIS/AHMIA Guidelines to Achieving a Compliant Query ProcessIdentifies 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 appropriateUtilizes the appropriate UAB query template and follows 2022 ACDIS/AHIMA Guidelines to Achieving a Compliant Query ProcessEnsures 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 recordDemonstrates 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 statusAbility to appropriately apply and use hospital approved clinical indicators for specified diagnosesAbility 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 recordMaintains productivity and established performance benchmarks for qualityEnsures 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 ROMEnsures 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 assignmentCollaborates 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 codersParticipates in departmental and hospital committees, assigned task forces, including service line assignment meetings as requestedContributes to a positive and collaborative working environmentComply with HIPAA and code of conduct policiesWhat 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 license2 + years acute care inpatient hospital coding or CDI experienceFamiliarity with encoder and DRG assignmentMaintain current working knowledge of official coding guidelines and coding clinicsWhat Would Be Nice to Have:CCDS or CDIP certificationStrong 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 processesExcellent 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#LI- DNIThe 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.Benefits include:Medical, Rx, Dental & Vision InsurancePersonal and Family Sick Time & Company Paid HolidaysPosition may be eligible for a discretionary variable incentive bonusParental Leave401(k) Retirement PlanBasic Life & Supplemental LifeHealth Savings Account, Dental/Vision & Dependent Care Flexible Spending AccountsShort-Term & Long-Term DisabilityTuition Reimbursement, Personal Development & Learning OpportunitiesSkills Development & CertificationsEmployee Referral ProgramCorporate Sponsored Events & Community OutreachEmergency Back-Up Childcare ProgramAbout GuidehouseGuidehouse 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.If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [e-mail]. 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. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [e-mail]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.