Clinical Documentation Integrity (CDI) Specialist- 2nd Level Reviewer- Remote

Job Family:

Travel Required:

Clearance Required:

Organization Impact & Communication
- Assists on mid to large or complex projects or processes within own job area
- Achieves operational targets with direct impact on results
- Assists in developing original solutions to existing problems within job area, may require collaboration with internal expertise and deep analysis
- Communicates with parties within and outside of own job function. May have responsibility for communicating with parties external to the organization (e.g., customers, vendors, etc.)

Innovation & Complexity
- Seasoned technical individual contributor
- Works independently on large or complex projects and assignments, with minimal guidance
- Works to influence parties within and outside of the job function at an operational level regarding policies, practices, and procedures
- Problems and issues faced are difficult and may require understanding of broader set of issues. Problems typically involve consideration of multiple issues, job areas or specialties. Problems are typically solved through drawing from prior experience and analysis of issues.

Leadership & Talent Management
- May manage projects while delegating work to lower-level employees
- Requires ability to participate in cross- department discussions to influence job area processes

Knowledge & Experience
- Requires advanced understanding and ability to apply standards, principles, theories, and technical concepts obtained through advanced education combined with experience
- Exhibits practical knowledge of project management
- Requires a University Degree and minimum 4-6 years of prior relevant experience; some roles may require graduate-level education Master’s or Doctorate degree (Relevant experience may be substituted for formal education or advanced degree)

What You Will Do:

The CDI Specialist- 2nd Level Reviewer responsibilities include comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, act as a liaison between coding and CDI to resolve DRG or other code discrepancies, collaborate with CDI educator to educate CDI team based on opportunities identified in second level reviews and work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and/or provider education.  The Clinical Documentation Integrity Second Level Reviewer will 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. This position is 100% remote.

• 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.
• 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 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 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 or licensed by endorsement 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
• Previous Vizient experience
• Previous Optum CAC experience
• 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
• Ability to conduct meaningful conversations and/or presentations with providers in all situations
• Excellent communication skills, with ability to listen and understand client request and needs while employing tact and effectiveness

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 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.

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 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com.  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

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.