RN CDI Specialist: Elevate Documentation & DRG Accuracy

Carle; Champaign, Northern (IL, KY); Hybrid; USD 47,000 - 81,000; Full time

Job summary

Carle Health is seeking a Clinical Documentation Improvement (CDI) specialist to review inpatient charts and ensure accurate documentation supporting DRG assignments, severity of illness, and mortality indicators. The role collaborates with physicians, nurses, and HIM coders to capture principal and secondary diagnoses and procedures.

Required: 2 years CDI experience and 2 years bedside clinical experience; RHIA or RN license within 6 months; associate degrees in Nursing or Health Information

Qualifications

• 2 years CDI experience
• 2 years clinical bedside experience
• RHIA or RN license within 6 months (if licensed in another state)

Responsibilities

• Conducts initial concurrent review for all selected admissions
• Clarifies documentation with physicians, nurses, and staff
• Ensures chart reflects true clinical picture and supports DRG
• Documents findings in Carle CDI software
• Coordinates with physicians, nurses, and HIM coding staff to capture Diagnoses and Procedures
• Follows query process and escalates as needed
• Performs education related to CDI topics
• Reviews denials and prepares appeal letters
• Follows workflow in EPIC and CDI software
• May participate in testing for upgrades

Skills

CDI

Nursing bedside experience

Education

Associate's Degree Nursing

Associate's Degree Health Information Mgmt

Doctorate degree Medicine

Tools

RHIA

Job description

Carle Health is seeking a Clinical Documentation Improvement (CDI) specialist to review inpatient charts and ensure accurate documentation supporting DRG assignments, severity of illness, and mortality indicators. The role collaborates with physicians, nurses, and HIM coders to capture principal and secondary diagnoses and procedures.

Required: 2 years CDI experience and 2 years bedside clinical experience; RHIA or RN license within 6 months; associate degrees in Nursing or Health Information