CDI Auditor

Guthrie Enterprise•Sayre, PA

About The Position

Performs advanced clinical documentation reviews to ensure the accuracy, completeness, and integrity of medical records in support of quality outcomes, reimbursement, and regulatory compliance. The role conducts second-level reviews of complex cases, including mortality reviews, denial validation, and Patient Safety Indicator (PSI) and Hospital-Acquired Condition (HAC) reviews. It identifies documentation gaps, validates clinical accuracy, and tracks organizational risk patterns. The CDI Auditor collaborates with CDI leadership and interdisciplinary partners to support continuous feedback, improve documentation, and reduce organizational risk. The position requires a Bachelor of Science in Nursing (BSN) and CCDS certification; a master's degree is preferred. Candidates must have prior CDI experience, including advanced review experience, and at least five years of clinical experience in an acute care setting. The role may require travel to other Guthrie entities as needed.

Requirements

Bachelor of Science in Nursing (BSN) required.
CCDS certification required.
Prior CDI experience required, with a minimum of 3–5 years in CDI, including advanced review experience.
Minimum of five years of clinical experience in an acute care setting required.
Strong analytical, critical-thinking, and problem-solving skills.
Ability to evaluate complex clinical scenarios and identify documentation and coding inconsistencies.

Nice To Haves

Master’s degree preferred.
Experience with mortality review, denial management, clinical validation, and DRG integrity strongly preferred.

Responsibilities

Performs second-level clinical documentation reviews, including retrospective and concurrent evaluations of complex inpatient cases.
Conducts comprehensive mortality reviews to validate documentation accuracy, risk adjustment (SOI/ROM), and alignment with coded outcomes.
Identifies opportunities affecting observed-versus-expected (O/E) mortality performance.
Reviews payer denials for clinical validity, documentation support, and DRG integrity; identifies root causes and trends to support denial prevention and appeal strategies.
Reviews Patient Safety Indicators (PSIs) and Hospital-Acquired Conditions (HACs) to ensure accurate documentation and alignment with reported outcomes.
Validates clinical diagnoses and documentation against coding guidelines, clinical validation standards, and regulatory requirements.
Identifies and trends documentation risks, gaps, and opportunities across mortality, denials, PSI/HAC, and high-risk clinical scenarios.
Provides structured insights and recommendations for performance improvement initiatives and program development.
Collaborates with CDI, Coding, Quality, and Revenue Cycle teams to resolve discrepancies and improve documentation integrity.
Supports development of appeal rationales and documentation strategies for complex or disputed cases.
Maintains current knowledge of coding guidelines, clinical validation expectations, and regulatory requirements.
Participates in process improvement initiatives to enhance documentation accuracy, reduce denials, and improve quality outcomes.
Participates in departmental and organizational committees and task forces.
May travel to other Guthrie entities as needed.
Performs other duties as assigned.