CDI Technical Advisor

Mass General Brigham•Somerville, MA

7d•Remote

About The Position

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The position reports to the senior leadership and conducts advanced clinical documentation reviews for inpatient encounters to ensure accuracy and compliance with MGB standards and regulatory requirements. This position provides quality assurance for primary CDI reviews, supports accurate code assignment and DRG validation, and ensures optimal reimbursement and data quality for CMS and commercial payors.

Requirements

Associate's Degree Nursing, Advanced Degree Nurse Practitioner or Physician Assistant preferred
Active and Current Registered Nurse License, Nurse Practitioner License or Physician Assistant License required
5 - 7 years of acute medical/surgical care experience required
3 - 5 years of clinical documentation improvement experience required
Strong knowledge of clinical documentation standards, coding guidelines, and regulatory requirements.
Excellent analytical and problem-solving skills to assess and improve documentation practices.
Effective communication and interpersonal skills to collaborate with physicians, coders, and other staff.
Proficiency in health information systems and electronic medical record platforms.
Ability to provide education and training to clinical and administrative teams.
Detail-oriented with strong organizational skills to manage multiple tasks and meet deadlines.

Responsibilities

Identify discrepancies or missed opportunities in clinical documentation that impact the severity of illness, risk of mortality, DRG assignment, and reimbursement through second-level CDI reviews.
Escalate complex cases to the CDI leadership team or physician advisors, as needed.
Demonstrate service-line expertise for targeted DRG assignment validation.
Facilitate communication between vendor-supported primary CDI staff and Coding.
Perform pre- and post-bill audits to ensure an accurate reflection of the patient’s clinical picture and acuity, with a specific focus on the impact of CMS and commercial payors.
Provide oversight and quality assurance for the CDI and Coder reconciliation process.
Manage and track retro-query coding requests to CDI.
Support the provider query escalation process.
Identify, monitor, and communicate trends and/or gaps in clinical documentation and/or CDI practices.
Maintain up-to-date knowledge of inpatient coding guidelines, CDI practices, CMS/OIG regulatory changes, and AHA Coding Clinic.