Clinical Documentation Integrity (CDI) DRG Auditor

Emory • Atlanta, GA

17h

About The Position

The Lead Clinical Documentation Integrity (CDI) DRG Auditor works under the direction of the Associate Director of CDI Quality and Education. This position is responsible for identifying areas of documentation improvement such as DRG accuracy, compliance, severity of illness, risk of mortality and risk adjustment factors during inpatient medical record review. Audits will be conducted retrospectively (post-discharge, pre-bill) once final coding has been completed. The Lead CDI DRG Auditor will perform pre-bill reviews from opportunities identified through internal referrals, organizational initiatives (e.g., Physician service lines, data analytics) and other various sources. The Lead CDI DRG Auditor will utilize an audit tool to enter findings, send feedback, track and trend data to identify areas of opportunity. The Lead CDI DRG Auditor will review the results with the Associate Director of CDI Quality and Education and relevant stakeholders. The Lead CDI DRG Auditor will work closely with multidisciplinary teams including Coding DRG Auditors and second level physician reviewers to justify all clinically supporting documentation for coding accuracy. The Lead CDI DRG Auditor is considered to be a subject matter expert in basic and intermediate CDI and coding concepts. The Lead CDI DRG Auditor will work closely with the multidisciplinary team to provide the status of reviews and propose topics for clinical documentation improvement opportunities/education required. This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a strong acumen to teamwork and collaboration. Other duties as deemed necessary, which may include supporting and managing work outside of focus audits such as quality reviews, educational presentations, and any other business needs or workload demands, or other projects that correlate with the growth/scope of the department.

Requirements

• Graduate of an accredited school of nursing, or United States or International School of Medicine degree.
• At least 5 years in healthcare related field with strong clinical expertise and acumen.
• Active CDI Certification (CDIP or CCDS).
• Coding Certification (CCS) required or obtained within six months of hire date.
• For RNs, must have an active license.
• All nurses employed in the role requiring an unencumbered nursing license must have a valid active license or temporary permit approved by the Georgia Licensing Board.

Nice To Haves

• Preferred critical care clinical experience.
• Education and experience may be considered in lieu of an RN License for qualified candidates (physicians).

Responsibilities

• Performs all the requirements of the Lead CDI DRG Auditor.
• Identifies areas of documentation improvement such as DRG accuracy, compliance, severity of illness, risk of mortality and risk adjustment factors during inpatient medical record review.
• Conducts retrospective audits (post-discharge, pre-bill) once final coding has been completed.
• Performs pre-bill reviews from opportunities identified through internal referrals, organizational initiatives, data analytics and other various sources.
• Utilizes an audit tool to enter findings, send feedback, track and trend data to identify areas of opportunity.
• Reviews results with the Associate Director of CDI Quality and Education and relevant stakeholders.
• Works closely with multidisciplinary teams including Coding DRG Auditors and second level physician reviewers to justify all clinically supporting documentation for coding accuracy.
• Provides the status of reviews and proposes topics for clinical documentation improvement opportunities/education required.
• Supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a strong acumen to teamwork and collaboration.
• Supports and manages work outside of focus audits such as quality reviews, educational presentations, and any other business needs or workload demands, or other projects that correlate with the growth/scope of the department.

Benefits

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives
• Ongoing mentorship and leadership programs

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 11-50 employees