Clinical Documentation Integrity, Second Level Reviewer

Job Description: • Perform high-level, complex, secondary case reviews to facilitate and obtain appropriate provider documentation for clinical conditions or procedures • Ensure accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes • Perform secondary case reviews to identify potential gaps or opportunities to facilitate improved provider documentation • Ensure clinical documentation accurately reflects the level of care rendered, severity of illness, risk of mortality, and clinical validation • Apply advanced knowledge of CMS star rating, Vizient, and US News and World Report risk-adjustment systems to identify clinical documentation improvement opportunities • Complete quality reviews focused on CDI quality elements, such as Mortality, Hospital Acquired Conditions (HAC), and other publicly reported patient quality or safety metrics • Identify trends and key areas for improvement in querying, coding, and documentation integrity • Demonstrate proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG • Communicate and collaborate effectively with providers, HIM/coding, quality, CDI, and other members of the healthcare team Requirements: • Four (4) Year/bachelor’s degree required • BSN/BS/BA in related field Required • Graduate degree in Healthcare Administration, Informatics, Nursing, Leadership, Education or related field preferred • Current RN or MD required • CCDS or CDIP certification required • Coding certification (CCS, CIC, or CPC) preferred • At least three (3) years recent inpatient clinical documentation improvement (CDI) experience required • Demonstrated extensive clinical knowledge • At least three (3) years of direct patient care clinical experience in hospital setting preferred • Proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG required • At least one (1) year experience with mortality, PSI, HAC, or other quality-focused reviews required • Knowledge of Vizient, Premier, US News and World Report, CMS star rating or similar risk-adjustment methodologies highly preferred • Prior experience in an academic medical center (AMC) or large health system preferred • Proficiency with Microsoft Office (Excel, PowerPoint, Word, Outlook) required • Proficiency with CDI software and encoder required • Experience with 3M 360 Encompass preferred Benefits: • medical • dental • tuition remission • competitive salaries