What are the responsibilities and job description for the Remote - Clinical Documentation Integrity (CDI) Specialist - 2nd Level Reviewer position at Guidehouse?
**Job Family** **:**
Clinical Appeals Nurse
**Travel Required** **:**
None
**Clearance Required** **:**
None
**What You Will Do** **:**
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.
Complete 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 UAB for potential missed opportunities to clarify documentation or clinically validate a diagnosis.
Acts as a liaison between the Coding Department and the Clinical Documentation Specialist to reconcile discrepancies in code and/or DRG assignment
Communicates findings of secondary reviews to respective Clinical Documentation Specialist for follow-up and query initiation.
Collaborates with CDI educator/quality auditor when educational needs are identified from second level reviews
Documents and tracks second level reviews and results. Shares this information with staff at monthly CDI team meeting.
Collaborative interaction with physicians and/or other clinicians to enhance understanding of the CDI program goals; ensure the medical record can be coded accurately in order to accurately reflect patient severity of illness and risk of mortality
**What You Will Need** **:**
Graduation from accredited School of Nursing; BSN or Bachelors degree in health related field and/or Masters required OR
Graduation from accredited medical school; MD or DO required
Minimum of five (5) years as a Clinical Documentation Integrity Specialist required. Minimum of five (5) years as an RN required.
Exhibits strong clinical, critical thinking skillset
Experienced Clinical Documentation Integrity Specialist (minimum 5 years) or CDI Second Level Reviewer 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 (HACs) , patient safety indicators (PSIs) and mortality models.
Experience with encoder and DRG assignments (MS and APR)
Maintains working knowledge of official knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system
Excellent communication skills, with ability to listen and understand client request and needs while employing tact and effectiveness
Ability to conduct meaningful conversations and /or presentations with providers in all situations
Currently licensed or licensed by endorsement as a Registered Nurse, MD or MD equivalent or credentialed coder with current CCS credential.
CCDS or CDIP Certification required.
Must maintain credentials while employed
**What Would Be Nice To Have** **:**
CCS preferred (exception required by coder)
The annual salary range for this position is $88,100.00-$154,100.00. 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 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 & Dependent 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
**About Guidehouse**
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, 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
_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._
Recommended Skills
- Active Listening
- Auditing
- Billing
- Certified Nurse Practitioner
- Clinical Works
- Communication
Salary : $88,100 - $0