Lead CDI Specialist Second Level Reviewer

At Garnet Health, the Hudson Valley’s leading integrated health system, you’ll find the perfect balance of a satisfying career and a rewarding lifestyle. Our focus is on patient-centric care with a collective of visionary leaders and dedicated, caring professionals working as a team to deliver the best for the people we serve.

About the Role

The Lead CDI Specialist – Second Level Reviewer performs advanced secondary reviews of complex clinical documentation, coding opportunities, and provider queries to ensure accuracy, compliance, clinical integrity, and appropriate reimbursement. This role supports accurate capture of severity of illness, risk of mortality, and other quality and reimbursement indicators. The Lead CDI second-level reviewer also provides 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. The role identifies trends, opportunities, and areas of risk and provides findings and recommendations to support ongoing improvement of CDI, coding, and AI-assisted workflows.

Responsibilities

• Perform advanced secondary reviews of complex clinical documentation, coding opportunities, and provider queries.
• 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 AI-assisted CDI software, including evaluation of AI-generated logic and recommendations.
• Analyze acceptance and rejection patterns and assess overall accuracy against organizational, AHIMA, and ACDIS guidelines.
• Identify trends, opportunities, and areas of risk.
• Provide findings and recommendations to support ongoing improvement of CDI, coding, and AI-assisted workflows.

Requirements

• Bachelor's Degree in Nursing.
• Five (5) years of progressive acute care clinical experience.
• 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.
• Excellent written and verbal communication skills.
• 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.

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. Required 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 the role is $48.8534 - $57.9004 per hour.

Schedule

Fully remote from the following states: Pennsylvania, Florida, South Carolina, North Carolina, Texas.

Benefits

• Comprehensive health, dental, and retirement benefits designed to fit individual and family needs.
• Tuition reimbursement programs for continued education.
• Resources to help you excel in your career.
• Inclusive and diverse team culture.