Specialist

Insight Global; Nashville (TN); On-site; USD 70,000 - 100,000; Full time

Job summary

Insight Global is seeking a clinical documentation improvement professional to review documentation for accuracy and regulatory compliance in inpatient settings. You will work with physicians and staff to clarify records and perform PDX shifting to reflect patient conditions accurately.

The role emphasizes identifying CDI opportunities, formulating precise physician queries, and collaborating with coding and revenue cycle teams, while supporting quality metrics and compliance initiatives.

Qualifications

• Active RN license and inpatient CDI experience
• Hands-on PDX shifting experience
• Ability to discern when a primary diagnosis should change
• Independently identify CDI opportunities
• Strong physician query formulation skills
• Cannot rely solely on 3M to identify opportunities or craft queries
• Candidates must not hold another job concurrently
• Able to take and apply feedback
• Clinical background valued (ICU/charge nurse bedside)
• Capable of meeting productivity metrics

Responsibilities

• Review clinical documentation for accuracy, completeness, and regulatory compliance
• Collaborate with physicians and clinical staff to clarify documentation
• Perform Primary Diagnosis (PDX) shifting to reflect patient conditions accurately
• Identify opportunities for documentation improvement and reimbursement optimization
• Collaborate with coding and revenue cycle teams
• Support quality metrics and compliance initiatives

Skills

Active RN license

CDI experience

PDX shifting

physician queries

independent CDI opportunities

clinical background (ICU/charge nurse/

Education

Active RN license (RN)

CDI certification (preferred)

Tools

3M CDI tools

Job description

Day-to-Day Responsibilities Review clinical documentation to ensure accuracy, completeness, and regulatory compliance Work directly with physicians and clinical staff to clarify documentation Perform Primary Diagnosis (PDX) shifting when appropriate to accurately reflect patient conditions and severity Identify opportunities for documentation improvement and reimbursement optimization Collaborate with coding and revenue cycle teams Support quality metrics and compliance initiatives

Must Haves:

• Active RN license required 2+ years of CDI experience within inpatient acute care in the last 5 years
• Must be able to demonstrate hands-on PDX shifting
• Understand when the primary diagnosis should be changed to a more appropriate diagnosis
• Must be able to identify CDI opportunities independently
• Strong ability to formulate appropriate physician queries
• Cannot depend solely on 3M to identify opportunities or formulate the query
• Candidates cannot be working another job simultaneously
• Ability to take and implement feedback
• Strong clinical background, with ICU, charge nurse, or bedside nursing experience being valuable
• Ability to identify documentation opportunities and independently formulate queries
• Ability to consistently meet required productivity metrics

Plusses:

• CCDS, CDIP, RHIA, RHIT, RN, or related certification
• Experience in large health systems or revenue cycle environments
• Advanced knowledge of DRG optimization, CC/MCC capture, and coding guidelines