CORP CDI AUDITOR-EDU

Position Summary

The CDI Auditor/Educator at Covenant Health performs and reviews complex internal coding and clinical documentation audits for inpatient CDI accounts. This role leads or conducts audit projects across Covenant Health entities, focusing on coding, documentation, and billing compliance. The position also provides consulting services, coordinates coding investigations, and is responsible for education and training of CDI staff.

Responsibilities

• Identify and evaluate risk areas; develop and implement CDI auditing procedures related to documentation and reimbursement.
• Collaborate with coders and CDI staff to provide education and feedback; proactively addresses issues with CDI management.
• Monitor CMS and OIG publications to ensure compliance with coding, billing, and reimbursement regulations.
• Reviews third-party payers guidelines to ensure accurate claims charging, coding, and billing.
• Communicate audit results through written reports and presentations to relevant stakeholders.
• Documents audit activities and report findings regularly.
• Serve as a resource for hospital departments regarding coding and documentation.
• Conduct CDI audits with regards to payor denials if/when necessary.
• Collaborate with health information management, Revenue Integrity, patient accounting, and other departments to implement compliance solutions.
• Support the Chief Compliance Officer on coding, billing and reimbursement compliance issues.
• Performs ongoing audits to identify process improvement education opportunities.
• Delivers detailed ICD-10 training to CDI staff.

Qualifications

• Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
• Minimum Experience: Three (3) to five (5) years’ experience in CDI.
• Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations.
• Experience in problem solving, analytical reviews.
• Must be knowledgeable in use of PC's, Windows, Excel and Word Processing.
• Must have good public relations, educational skills.
• Licensure Requirement: Certification in field of study. The following certifications are acceptable: RHIT/RHIA, CCS, CCDS, or CDIP.