Job Family:

Travel Required:

Clearance Required:

What You Will Do:

The Clinical Documentation Integrity Specialist reviews and analyzes health records to identify opportunities to clarify relevant diagnoses and procedures for distinct patient encounters.  Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes, and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.

Duties and Responsibilities:

• Conducts comprehensive initial and follow-up concurrent reviews of medical records for assigned patients in the time frame, frequency and prioritization as defined for the CDI team 

• Identifies opportunities to clarify incomplete or conflicting documentation and/or to validate diagnosis in the medical record.

• Understands the guiding principles of clinical validation and writing a compliant query

• Prepares a compliant written query for responsible treating physician, following the most current ACDIS/AHMIA Guidelines to Achieving a Compliant Query Process

• Identifies principal diagnosis options, secondary diagnoses and significant procedures in order to assign working MS-DRG.

• Establishes a working DRG and updates DRG based on record documentation during concurrent reviews to reflect current expected Length of Stay as appropriate

• Utilizes the appropriate UAB query template and follows 2022 ACDIS/AHIMA Guidelines to Achieving a Compliant Query Process

• Ensures relevant and/or approved clinical indicators specific to the patient and the clinical record are cited on the query template.

• Choices provided on the query must reflect reasonable conclusions specific to the patient and the clinical record

• Demonstrates knowledge of Patient Safety Indicator’s (PSI’s), Hospital Acquired Conditions (HAC’s), Severity of Illness & Risk of Mortality (SOI/ROM) as well as present on admission status

• Ability to appropriately apply and use hospital approved clinical indicators for specified diagnoses

• Ability to follow hospital specific procedures and policies with regards to documentation requirements, query escalation, DRG reconciliation and other duties.

• Tracks physician query response documented in the medical record

• Maintains productivity and established performance benchmarks for quality

• Ensures competency in use of CDI application to process and prioritize daily work lists, capture results of record reviews, track queries and query responses.

• Enters all required data into CDI application and/or other systems to enable coders and CDI/Coding auditors to determine disposition of concurrent queries in order to assign the final MS-DRG as well as SOI and ROM

• Ensures competency in use of electronic coding references to code and assign working MS-DRG along with, SOI and ROM; as well as reference related Official Coding Guidelines and Coding Clinic for accurate code assignment

• Collaborates with Coding team on any questions related to ICD-10 coding and/or MS-DRG assignment, involved in the preparation of concurrent and/or retrospective queries.

• Participates in DRG reconciliation process in a collaborative, timely, and thorough manner with coders

• Participates in departmental and hospital committees, assigned task forces, including service line assignment meetings as requested

• Contributes to a positive and collaborative working environment

• Comply with HIPAA and code of conduct policies

What You Will Need:

• Bachelor’s degree (Relevant experience may be substituted for formal education or advanced degree)

• At least one of the following: RN, MD or MD Equivalent, RHIA, RHIT, CCS, with a current/active license

• 2 + years acute care inpatient hospital coding or CDI experience

• Familiarity with encoder and DRG assignment

• Maintain current working knowledge of official coding guidelines and coding clinics

What Would Be Nice to Have:

• CCDS or CDIP certification

• Strong clinical understanding of disease process.

• Demonstrate critical thinking, analytical skills, and ability to resolve problems.

• Strong knowledge of medical terminology, anatomy, physiology, microbiology, and disease processes

• Excellent communication skills, employing tact and effectiveness.

• Ability to converse with physicians in sometimes difficult scenarios.

• Strong typing and computer skills; proficiency with EHR systems, CDI software systems and encoders

#LI- DNI

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• 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

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.