Clinical Documentation Auditor

Guthrie Enterprise • Sayre, PA

1d

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. Conducts second-level reviews of complex cases, including mortality reviews, denial validation, and PSI/HAC reviews. Identifies documentation gaps, validates clinical accuracy, and trends organizational risk patterns. Collaborates with CDI leadership and interdisciplinary partners to support continuous feedback that improves documentation and reduces organizational risk.

The role includes retrospective and concurrent review of complex inpatient cases, mortality reviews, payer denial reviews, and focused reviews of Patient Safety Indicators (PSIs) and Hospital-Acquired Conditions (HACs). It also supports performance improvement, denial prevention and appeals, and the development of documentation strategies for complex or disputed cases. The position may require travel to other Guthrie entities as needed and includes other duties as assigned.

Requirements

• Bachelor of Science in Nursing (BSN) required.
• CCDS certification required.
• Prior CDI experience, with a minimum of 3–5 years in CDI, including advanced review experience.
• Minimum of 5 years of clinical experience in an acute care setting.
• 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 evaluation 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 denial root causes and trends to support denial prevention and appeal strategies.
• Performs focused reviews of Patient Safety Indicators (PSIs) and Hospital-Acquired Conditions (HACs) to ensure accurate documentation and alignment with reported outcomes.
• Validates clinical diagnoses and documentation for compliance with 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 rationale 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 improve 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level