Second Level Reviewer-Clinical Documentation Integrity

US104 Guidehouse Managed Services LLC; Greenville (NC); Hybrid; USD 89,000 - 148,000; Full time

Benefits offered by this job

Medical

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Sick time & Holidays

Job summary

Guidehouse is seeking a CDI Specialist (Second Level Reviewer) to perform detailed chart reviews, ensuring documentation supports severity of illness and risk of mortality. You will work with CDI teams, physicians, and quality staff to drive compliant queries and accurate coding.

The role requires nursing or medical credentials, current licensure, and 4–6 years of CDI or inpatient coding experience. You will use EHR/CDI software and adhere to AHIMA guidelines while advancing education and

Qualifications

• Graduation from accredited School of Nursing with BSN/ADN or MD-equivalent.
• Current licensed as RN, MD or AHIMA credentials (CCS/RHIA/RHIT) with CDIP or CCDS.
• 4–6 years of CDI or inpatient coding quality review experience.

Responsibilities

• Perform second-level reviews to ensure accurate DRG, codes and severity of illness.
• Collaborate with CDI team, physician advisors, and quality department.
• Document results and educate staff during sessions.
• Maintain HIPAA and conduct policies.

Skills

ACDIS best practices

Clinical documentation

Communication skills

EHR proficiency

Education

BSN/ADN or MD

Health-related degree

Tools

EHR systems

CDI software

Encoders

Job description

Job Family: CDI Specialist

Travel Required: None Clearance Required: None

What You Will Do

Second level reviewer responsibilities include comprehensive, clinical chart reviews to ensure the most accurate reflection of the patient’s care and diagnosis following Official Coding Guidelines, Coding Clinics, and client policies. The Clinical Documentation Integrity (CDI) Second Level Reviewer will collaborate closely with the CDI team, Physician Advisors, Providers, Clinicians, Coding Educator, Coding Quality Auditors, Case Managers and Quality Department to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards. Applies the Association of Clinical Documentation Integrity Specialist (ACDIS) best practices for writing clinical documentation integrity clarifications (see Achieving a Compliant Query) and follows the CDI Code of Ethics. Collaborates with CDI Management/Educator to identify opportunities for education with CDI team, Coding, Providers and/or other ancillary staff to improve the overall quality and completeness of documentation. The second level review role is dynamic, requiring adaptation to various clinical and administrative needs. This flexibility is essential for effectively addressing the evolving challenges in clinical documentation, ensuring the accuracy and compliance of patient records. The incumbent will navigate multiple responsibilities with agility, participating in diverse projects and initiatives that enhance documentation quality and patient care standards. Understands quality risk models and apply them during secondary reviews. Collaborate closely with Coders, Coding Educators, Coding Quality Auditors, Case managers, Quality Department and Providers to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards. Demonstrates excellent verbal and written communication skills, crucial for effective interaction with healthcare professionals and the creation of compliant queries. Acts as a liaison between the Coding Department and the Clinical Documentation Specialist to reconcile discrepancies in code and/or DRG assignment. Exhibits adeptness in quickly learning and adapting to new technologies. Proficient in utilizing EHR systems, CDI software, and encoders to optimize workflow and boost productivity. Apply the principles of clinical validation and ensure that queries are compliant with AHIMA guidelines.

Duties

Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for Compliant Query Writing. Demonstrated ability to collaborate with the Quality Department on annual quality initiatives. Completes comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and/or code discrepancies; mortality reviews to ensure documentation supports risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnosis as identified by the client for potential missed opportunities to clarify documentation or clinically validate a diagnosis. Consistently meet second level review productivity, quality, and turnaround expectations, including mailbox inquiries and mortality reviews, to support Guidehouse client metrics. Acts as a liaison between the Coding Department and the Clinical Documentation Specialist to reconcile discrepancies in code and/or DRG assignment. Collaborates with CDI educator/quality auditor when educational needs are identified from second level reviews Document and track the results of secondary reviews, sharing information during formal and informal education sessions to all stakeholders (CDI, Leadership, Physicians), via by engaging in collaborative interactions with physicians and other clinicians to enhance understanding of CDI program goals. Collaborative interaction with physicians and/or other clinicians to enhance understanding of the CDI program goals. Perform impartial audits of front-line CDI documentation using Guidehouse criteria, provide professional feedback and mentorship, and elevate unresolved disagreements through appropriate leadership channels. Participate in departmental and hospital committees, assigned task forces, and service line assignment meetings as requested. Contribute to a positive and collaborative working environment. Perform other duties as assigned. Comply with HIPAA and code of conduct policies.

What You Will Need

• Graduation from accredited School of Nursing with BSN, ADN OR Graduation from accredited medical school with MD or equivalent OR bachelor’s or master’s degree in health-related field
• Currently licensed as a Registered Nurse, MD or MD equivalent OR Credentialed Medical Coder through AHIMA with current CCS, RHIA or RHIT credential and CDIP or CCDS 4-6 years previous relevant experience in clinical documentation, or CDI second level review or inpatient coding quality review and/or DRG validation with a strong understanding of disease processes, clinical indications and treatments; provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors as well as a solid understanding of hospital acquired conditions (HAC’s), patient safety indicators (PSI’s) and mortality models
• Must maintain credentials while employed

What Would Be Nice to Have

• CCDS or CDIP certification
• Strong clinical and critical thinking skillset
• Experience with encoder and DRG assignments (MS and APR)
• Maintains working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system

Annual Salary Range

The annual salary range for this position is $89,000.00-$148,000.00.

Benefits

• 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 & Dependnt 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

Equal Opportunity Statement

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.

Company Information

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