Lead CDI DRG Auditor

Emory Healthcare•Atlanta, GA

10h

About The Position

JOB DESCRIPTION: The Lead Clinical Documentation Integrity (CDI) DRG Auditor works under the direction of the Associate Director of CDI Quality and Education. He/she performs all the requirements of the Lead CDI DRG Auditor. In addition, 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 retrospective (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 i.e. 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.
Must have at least 5 years in healthcare related field with strong clinical expertise and acumen.
For RNs, candidates 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.
Must have active CDI Certification (CDIP or CCDS), the addition of coding Certification (CCS) is required or obtained within six months of hire date.

Nice To Haves

Preferred critical care clinical experience.

Responsibilities

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
Conducting retrospective audits (post-discharge, pre-bill) once final coding has been completed
Performing pre-bill reviews from opportunities identified through internal referrals, organizational initiatives i.e. Physician service lines, data analytics and other various sources
Utilizing an audit tool to enter findings, send feedback, track and trend data to identify areas of opportunity
Reviewing results with the Associate Director of CDI Quality and Education and relevant stakeholders
Working closely with multidisciplinary teams including Coding DRG Auditors and second level physician reviewers to justify all clinically supporting documentation for coding accuracy
Providing the status of reviews and propose topics for clinical documentation improvement opportunities/education required
Providing quality customer service, participating in performance improvement efforts and demonstrating a strong acumen to teamwork and collaboration
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