RN CDI Specialist: Elevate Documentation & Hospital Revenue

Ensemble Health Partners; United States; On-site; USD 72,000 - 88,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking a CDI Specialist (RN) to obtain and verify documentation for patient conditions and procedures, ensuring accuracy in severity, ROM, and complexity of care. The role involves extensive medical record review and collaboration with physicians, nurses, and HIM coders.

Responsibilities include coding accuracy, DRG assignments, and education of clinicians on documentation standards.

Qualifications

• Minimum of five years acute care nursing experience (medical/surgical, ICU, or ED).
• Excellent verbal and written communication; strong physician relations.
• Ability to organize and present information clearly; proficient computer skills.

Responsibilities

• Completes initial patient medical record review within 24-48 hours of admission.
• Assigns principal diagnosis, CC/MCC, SOI, ROM; codes using encoder in CDE software.
• Clarifies with physicians for missing or conflicting documentation and obtains needed docs.
• Educates healthcare providers on clinical documentation improvement and guidelines.
• Partners with coding professionals to ensure data accuracy and DRG assignment; reviews denial letters.

Skills

Acute care nursing

Physician relations

Clinical documentation improvement

Communication skills

Education

Current RN Licensure

Tools

CDE software

ICD-10-CM coding

Job description

Ensemble Health Partners is seeking a CDI Specialist (RN) to obtain and verify documentation for patient conditions and procedures, ensuring accuracy in severity, ROM, and complexity of care. The role involves extensive medical record review and collaboration with physicians, nurses, and HIM coders.

Responsibilities include coding accuracy, DRG assignments, and education of clinicians on documentation standards.