Found Description
Responsibilities
- Perform high-level, secondary case reviews to ensure accurate and comprehensive provider documentation
- Perform CDI audits
- Assess documentation alignment with ICD-10-CM/PCS, MS-DRG/APR-DRG, and payer guidelines
- Identify missed or inappropriate diagnoses, procedures, CCs/MCCs, and severity of illness (SOI) / risk of mortality (ROM) opportunities
- Analyze audit findings and prepare detailed reports with trends, risks, and improvement opportunities
- Provide feedback and education to CDI specialists, coders, and clinical staff
Requirements
- CCDS or CDIP certification required
- Minimum of 3 years of CDI experience
- Thorough knowledge of official medical coding guidelines, CMS, and private payer regulations
- Experience performing CDI Audits and second level reviews
- Ability to communicate collaboratively with physicians and hospital staff