Second Level Reviewer – Clinical Documentation Integrity
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Job Description
Clinical documentation integrity reviewer conducting compliant secondary chart reviews for Guidehouse healthcare clients. Validating diagnoses, DRGs and mortality documentation while coordinating coding education and quality initiatives.
Responsibilities:
- Conduct comprehensive clinical chart reviews to ensure accurate reflection of patient care and diagnoses
- Perform secondary reviews of targeted patient populations, including DRG/code discrepancies, mortality reviews, HACs, PSIs and priority diagnoses
- Analyze clinical data to identify documentation gaps, inconsistencies and improvement opportunities
- Query providers using the concurrent query process according to ACDIS/AHIMA compliant query-writing guidelines
- Apply clinical validation principles and quality risk models during secondary reviews
- Collaborate with CDI staff, Physician Advisors, providers, clinicians, coding educators, coding quality auditors, case managers and the Quality Department
- Reconcile discrepancies in codes and/or DRG assignments between Coding and Clinical Documentation Specialists
- Meet second-level review productivity, quality and turnaround expectations, including mailbox inquiries and mortality reviews
- Collaborate with CDI educators and quality auditors to identify educational needs
- Document and track secondary review results and share findings in education sessions
- Perform impartial audits of frontline CDI documentation, provide feedback and mentorship, and escalate unresolved disagreements
- Participate in departmental and hospital committees, task forces and service line meetings
- Contribute to a positive and collaborative working environment
- Perform other assigned duties
- Comply with HIPAA and code of conduct policies
Requirements:
- Requires a University Degree and minimum 4-6 years of prior relevant experience; relevant experience may be substituted for formal education or advanced degree
- Currently licensed as a Registered Nurse, MD or MD equivalent OR credentialed medical coder through AHIMA with current CCS, RHIA or RHIT credential and CDIP or CCDS
- 4-6 years previous relevant experience in clinical documentation, CDI second level review, inpatient coding quality review and/or DRG validation
- Strong understanding of disease processes, clinical indications and treatments
- Understanding of provider documentation requirements for severity of illness, risk of mortality and diagnosis/procedure support for accurate clinical coding and billing
- Knowledge of Medicare, Medicaid and commercial payor rules
- Understanding of hospital acquired conditions (HACs), patient safety indicators (PSIs) and mortality models
- Must maintain credentials while employed
- Strong clinical and critical thinking skillset
- Experience with encoder and DRG assignments (MS and APR)
- Working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system
- Excellent verbal and written communication skills
- Proficiency with EHR systems, CDI software and encoders
- Knowledge of ACDIS and AHIMA compliant query guidelines
- Ability to quickly learn and adapt to new technologies
- Must comply with HIPAA and code of conduct policies
Benefits:
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Flexible benefits package
- Flexible work arrangements (remote)
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