Lead CDI Specialist Second Level Reviewer

About the Role

Join Garnet Health, the Hudson Valley’s leading integrated health system, as a Lead Clinical Documentation Specialist 2nd Level Reviewer. This role offers the perfect balance of a satisfying career and a rewarding lifestyle, focusing on patient-centric care within a growing, award-winning health system. You’ll serve a diverse community and enjoy the best of both city and rural life at Garnet Health Medical Center-Middletown.

Responsibilities

• Perform advanced secondary reviews of complex clinical documentation, coding opportunities, and provider queries to ensure accuracy, compliance, clinical integrity, and appropriate reimbursement.
• Support accurate capture of severity of illness, risk of mortality, and other quality and reimbursement indicators.
• Provide advanced oversight of the organization’s AI-assisted CDI software, including evaluation of AI-generated logic, recommendations, acceptance and rejection patterns, and overall accuracy against organizational, AHIMA, and ACDIS guidelines.
• Identify trends, opportunities, and areas of risk, and provide findings and recommendations to improve CDI, coding, and AI-assisted workflows.

Requirements

• Bachelor's Degree in Nursing.
• Five (5) years of progressive acute care clinical experience and three (3) years of CDI experience.
• Strong knowledge of ICD-10-CM/PCS coding guidelines, DRG methodologies, and inpatient reimbursement.
• Experience performing CDI audits, quality reviews, and second-level reviews.
• Knowledge of DRG validation, clinical validation, coding denials, and appeal processes.
• Advanced knowledge of inpatient CDI practices and compliant query guidelines.
• Strong analytical, auditing, critical-thinking, and problem-solving skills with the ability to independently evaluate complex clinical and coding scenarios.
• Excellent written and verbal communication skills with the ability to clearly communicate findings and recommendations to clinical and non-clinical stakeholders.
• Proficiency with electronic medical records, CDI software, and Microsoft Office applications.
• Ability to work independently, manage multiple priorities, and meet deadlines in a remote environment.
• Strong organizational and interpersonal skills with the ability to build effective collaborative relationships.

Qualifications

• Current NYS RN license.
• Certified Clinical Documentation Specialist (CCDS) (Required).
• Certified Coding Specialist (CCS) (Preferred).

Working Conditions

• Environmental Demands and Exposure to Hazards: Works in a clean, lighted, heated or ventilated facility. No routine exposure to hazards.
• Physical Demands: Demonstrates physical and functional ability to perform full anatomical range of motion. Evidence of visual and aural acuity and finger and hand dexterity to operate computer and office equipment. Can withstand long periods of sitting, standing, and/or constant walking. Ability to lift 10 lbs.
• Mental Demands: Ability to foster collaborative relationships, work well under pressure, organize and synthesize new information, and prioritize tasks. Possesses critical thinking, analytical skills, and flexibility. Ability to multi-task. Requires detailed attention to work in an environment where interruptions cannot be controlled. Demonstrates sensitivity to customer needs and expectations. May be subject to irregular hours, including evenings or potentially weekends, to participate in operational and community events as necessary.

Pay

Compensation for this role is $48.8534 - $57.9004 per hour.

Schedule

This is a fully remote position available from the following states: Pennsylvania, Florida, South Carolina, North Carolina, and Texas.

Benefits

• Resources to support career growth and professional potential.
• Tuition reimbursement programs for continued education.
• Comprehensive health, dental, and retirement benefits designed to fit individual and family needs.
• Inclusive and diverse team culture that encourages contribution of exceptional talents, skills, and perspectives.