Lead CDI Specialist Second Level Reviewer

Garnet Health•Mechanicstown, NY

9d•Remote

About The Position

At Garnet Health, the Hudson Valley’s leading integrated health system, you’ll find the perfect balance of a satisfying career and a rewarding lifestyle. Our focus is on patient-centric care with a collective of visionary leaders and dedicated and caring professionals working as a team to deliver the best for the people we serve. If you’re interested in a health system that’s both growing and award-winning, serving a diverse community that provides the best of both city and rural life, we invite to make your career home with us as a Lead Clinical Documentation Specialist 2nd Level Reviewer on our Clinical Documentation Intergrity team at/in Garnet Health Medical Center-Middletown.

Requirements

Bachelor's Degree in Nursing
Five (5) years of progressive acute care clinical experience and three (3) years of CDI experience required.
Strong knowledge of ICD-10-CM/PCS coding guidelines, DRG methodologies, and inpatient reimbursement.
Experience performing CDI audits, quality reviews, and second-level reviews required.
Knowledge of DRG validation, clinical validation, coding denials, and appeal processes.
Advanced knowledge of inpatient CDI practices and compliant query guidelines.
Strong analytical, auditing, critical-thinking, and problem-solving skills with the ability to independently evaluate complex clinical and coding scenarios.
Excellent written and verbal communication skills with the ability to clearly communicate findings and recommendations to clinical and non-clinical stakeholders.
Proficiency with electronic medical records, CDI software, and Microsoft Office applications.
Ability to work independently, manage multiple priorities, and meet deadlines in a remote environment.
Strong organizational and interpersonal skills with the ability to build effective collaborative relationships.
Current NYS RN license
Certified Clinical Documentation Specialist (CCDS)

Nice To Haves

Certified Coding Specialist (CCS)

Responsibilities

Performing advanced secondary reviews of complex clinical documentation, coding opportunities, and provider queries to ensure accuracy, compliance, clinical integrity, and appropriate reimbursement.
Supporting accurate capture of severity of illness, risk of mortality, and other quality and reimbursement indicators.
Providing advanced oversight of the organization’s AI-assisted CDI software, including evaluation of AI-generated logic, recommendations, acceptance and rejection patterns, and overall accuracy against organizational, AHIMA, and ACDIS guidelines.
Identifying trends, opportunities, and areas of risk and provides findings and recommendations to support ongoing improvement of CDI, coding, and AI-assisted workflows.