Healthcare Clinical Documentation Integrity (CDI) Consultant

Berkeley Research Group • New York, NY

9d • $70,000 - $150,000 • Remote

About The Position

We do Consulting Differently BRG's Clinical Economics and Healthcare Performance Improvement practices currently have several openings for CDI experts to join our team at the Consultant level. The  Consultant  position is a mid-level consulting staff position. This position requires a highly motivated problem solver with strong analytical ability and a desire to advance within the organization.  An individual with an entrepreneurial spirit and an ability to apply creative solutions is a natural fit for this position. The Consultant is an integral part of the CDI team and works closely with the client’s CDI team, supporting classroom education and mentoring. They are responsible for ensuring the successful transfer of CDI best practices from the consulting team to the client team. The Consultant also facilitates accurate documentation for severity of illness (SOI) and quality in the medical record, which involves extensive record review and interaction with physicians, health information management professionals, coding professionals, and nursing staff. For candidates who are not based in the New York area, flexibility for travel (50-75%) is required for this position. Travel volume is dependent on project and client needs. About BRG BRG combines world-leading academic credentials with world-tested business expertise purpose-built for agility and connectivity, which sets us apart—and gets you ahead. At BRG, our top-tier professionals include specialist consultants, industry experts, renowned academics, and leading-edge data scientists. Together, they bring a diversity of proven real-world experience to economics, disputes, and investigations; corporate finance; and performance improvement services that address the most complex challenges for organizations across the globe. Our unique structure nurtures the interdisciplinary relationships that give us the edge, laying the groundwork for more informed insights and more original, incisive thinking from diverse perspectives that, when paired with our global reach and resources, make us uniquely capable to address our clients’ challenges. We get results because we know how to apply our thinking to your world. At BRG, we don’t just show you what’s possible. We’re built to help you make it happen. BRG is proud to be an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.

Requirements

• 4-7 years of experience as a Clinical Documentation Improvement (CDI) Specialist within a hospital setting or as a CDI consultant, or a combination thereof.
• RN, BSN, or Health Information Management degree required.
• Currently licensed as a Registered Nurse – ICU, OR, ED specialty preferred, with a strong understanding of clinical workflow.
• Minimum 2 years of inpatient coding experience with ICD-10 CM/PCS preferred.
• ACDIS or AHIMA certification preferred.
• Strong knowledge of CDI principles, including the ability to audit medical records, teach CDI principles to clinicians, coders, and other healthcare professionals.
• Experience in clinical documentation improvement, coding, audit, or Health Information Management.
• Ability to assist with the development of CDI and HIM training and consulting tools and methodologies.
• Excellent organizational, analytical, and writing skills, with the ability to demonstrate critical thinking and problem-solving.
• Strong verbal and written communication skills, with excellent public speaking and presentation abilities.
• Effective communication with physicians, coding professionals, and other stakeholders.
• Knowledge of regulatory guidelines and Medicare Part A, MS-DRG, and/or APR-DRG payment methodologies.
• Ability to pass a written clinical competency assessment.
• Familiarity with hospital systems such as EPIC, MEDITECH, or similar platforms is desired.
• Strong proficiency in MS Office applications, including Word, PowerPoint, Excel, and Outlook.
• Excellent time management skills and the ability to handle multiple priorities effectively.
• Candidate must be able to submit verification of his/her legal right to work in the U.S., without company sponsorship.

Responsibilities

• Review inpatient medical records for identified payer populations on admission and throughout hospitalization.
• Analyze clinical information to identify areas within the chart for potential gaps in physician documentation.
• Formulate credible clinical documentation clarifications to improve clinical documentation of principal diagnosis, co-morbidities, present on admission (POA), quality measures, and patient safety indicators (PSI).
• Facilitate modifications to clinical documentation through extensive interaction with physicians, nurses, and ancillary staff.
• Work collaboratively with the coding staff to assure documentation of discharge diagnoses and comorbidities are a complete reflection of the patient’s clinical status and care.
• Develop and implement plans for education of physician, nursing, and ancillary staff on documentation improvement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees