Second Level Reviewer – Clinical Documentation Integrity

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct thorough clinical chart reviews to ensure an accurate representation of patient care and diagnoses.

• Utilize Official Coding Guidelines, Coding Clinics, client policies, ACDIS best practices, and the CDI Code of Ethics.

• Execute secondary reviews of specified patient populations, including discrepancies in DRG/codes, mortality assessments, HACs, PSIs, and priority diagnoses.

• Analyze clinical data to uncover documentation gaps, inconsistencies, and areas for enhancement.

• Engage with providers through the concurrent query process following ACDIS/AHIMA compliant query-writing standards.

• Collaborate with CDI teams, Physician Advisors, providers, clinicians, Coding, Coding Educators, Coding Quality Auditors, Case Managers, and the Quality Department.

• Implement clinical validation principles and quality risk models during secondary reviews.

• Act as a liaison between Coding and Clinical Documentation teams to resolve discrepancies in code and/or DRG assignments.

• Achieve productivity, quality, and turnaround expectations, including responding to mailbox inquiries and conducting mortality reviews.

• Work with CDI educators and quality auditors to recognize and address educational needs.

• Document and monitor secondary review outcomes and present findings in educational sessions.

• Engage in collaborative discussions with physicians and clinicians to enhance understanding of CDI program objectives.

• Conduct unbiased audits of front-line CDI documentation, provide constructive feedback and mentorship, and escalate unresolved conflicts.

• Participate in committees, task forces, and service line assignment meetings.

• Adhere to HIPAA regulations and the code of conduct policies.

• Perform additional duties as assigned.

⛳️ Requirements

• Graduation from an accredited School of Nursing with a BSN, ADN, or graduation from an accredited medical school with an MD or equivalent, or a bachelor's or master's degree in a health-related field.

• Current licensure as a Registered Nurse, MD, or MD equivalent, or a credentialed Medical Coder through AHIMA with current CCS, RHIA, or RHIT credentials and CDIP or CCDS certification.

• 4-6 years of relevant experience in clinical documentation, CDI second-level review, inpatient coding quality review, and/or DRG validation.

• Strong knowledge of disease processes, clinical indications, and treatments.

• Understanding of provider documentation requirements regarding severity of illness, risk of mortality, diagnoses/procedures, and accurate clinical coding and billing.

• Familiarity with Medicare, Medicaid, and commercial payer regulations.

• Comprehensive understanding of hospital-acquired conditions (HACs), patient safety indicators (PSIs), and mortality models.

• Must maintain credentials while employed.

• Strong clinical and critical thinking abilities.

• Experience with encoder and DRG assignments (MS and APR).

• Working knowledge of Official Coding Guidelines, Coding Clinic, and federal updates to the DRG system.

• CCDS or CDIP certification.

• Proven verbal and written communication skills.

• Proficiency with EHR systems, CDI software, and encoders.

• Knowledge of ACDIS and AHIMA compliant query guidelines.

• Familiarity with CMS and other regulatory standards.

• Capacity to swiftly learn and adapt to new technologies.

🏝️ Benefits

• Medical, Rx, Dental & Vision Insurance.

• Personal and Family Sick Time & Company Paid Holidays.

• Position may qualify for a discretionary variable incentive bonus.

• Parental Leave.

• 401(k) Retirement Plan.

• Basic Life & Supplemental Life Insurance.

• Health Savings Account, Dental/Vision, & Dependent Care Flexible Spending Accounts.

• Short-Term & Long-Term Disability coverage.

• Tuition Reimbursement, Personal Development & Learning Opportunities.

• Skills Development & Certifications.

• Employee Referral Program.

• Corporate Sponsored Events & Community Outreach.

• Emergency Back-Up Childcare Program.

• Flexible benefits package.