CDI SPECIALIST CLINICAL

Position Summary

The CDI Specialist serves as a liaison between the physicians and hospital departments to promote consistency and efficiency in documentation and to facilitate data quality and compliance in hospital services. CDI is responsible for facilitating concurrent documentation reviews in the setting of an acute care facility. Concurrent reviews assure the completeness of medical records, the accuracy of documentation, and the appropriate assignment of a final DRG.

Responsibilities

• Facilitates concurrent documentation reviews in the setting of an acute care facility.
• Ensures the completeness and accuracy of medical records.
• Facilitates complete and accurate documentation of the inpatient record.
• Makes updates to working DRGs and SOI/ROM for final coding and DRG assignment.
• Prepares reports for any assigned facilities.
• Assists with the collection and maintenance of data reflecting the productivity and effectiveness of all CDI actions.
• Understands HACs, PSI, and POA issues as it relates to quality measures.
• Works in a collaborative fashion with Health Information Management and Coding Departments to assure that initial and final DRGs are correct.
• Assigns concurrent queries when required to assure that documentation is consistent and that diagnoses meet clinical definitions.
• Assists the HIM Department with post discharge queries as needed.
• Affirms the risk measures accurately reflect the severity and risk involved in patient’s care.
• Edits and educates physicians on coding versus clinical issues.
• Identifies opportunities for intradepartmental and interdepartmental operational improvements.
• Remains informed about annual changes pertinent to ICD-10-CM/PCS, follows through with educating appropriate parties, and applies information to concurrent reviews as needed.
• Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.
• Maintains activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported.
• Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.
• Increases awareness of compliance as it relates to coding and documentation.
• Applies knowledge related to proper documentation necessary to support MS-DRGs/APR DRGs/Medical Necessity/ROM/SOI assignment.
• Reconciles discharge and coded records to assure that queries have been answered and results are correctly assigned.
• Keeps current on local, state, and federal regulations to ensure compliance.
• Keeps current on coding guidelines and communicates to Health Information Manager.
• Implements corrective actions as indicated to minimize financial risk.
• Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.
• Ensures corrective action is taken to prevent denials from recurring.

Requirements

• Graduate from an accredited HIM program preferred.
• Four (4) years coding experience or relevant work with health systems either in acute care or outpatient settings.
• Effective interpersonal skills in order to interact effectively with all levels of hospital personnel.
• Organization and prioritization skills.
• Effective written and verbal communications skills.
• Analytical skills.
• Proficient computer skills.

Licensure Requirement

RN or equivalent/advanced clinical licensure. RN must be willing to obtain CDI certification within two (2) years of hire date. Employees hired prior to September 2025 may substitute the CDI certification with a CCS certification.