Revenue Cycle CDI Specialist
About The Position
The Revenue Cycle CDI Specialist reviews medical records to obtain appropriate provider documentation supporting accurate DRG assignment, severity of illness, risk of mortality, and complexity of care. The role applies clinical expertise and compliant query practices under AHIMA and ACDIS guidelines, acts as a liaison among providers, clinical quality, and patient financial services, and educates providers to protect the accuracy and integrity of the inpatient record. The specialist completes initial reviews within 24–48 hours of admission for an assigned patient population, conducts follow-up reviews every 2–3 days, and supports working DRG assignment. The role also formulates and follows up on compliant provider queries, reviews final coding and DRG assignments through the DRG reconciliation process, and stays current with coding and CDI guidelines, directives, and trends.
Requirements
- Two years of acute care hospital clinical CDI experience, or two years of experience as an inpatient coding auditor.
- Experience with encoder and EMR systems such as Optum eCAC, Solventum, EPIC, Cerner, or Meditech.
- Clinical expertise, CDI and compliant coding knowledge, and strong provider communication.
Nice To Haves
- Bachelor’s degree in Nursing or Health Information Management (HIM).
- CAC (Computer Assisted Coding) experience.
- Clinical Documentation Improvement Professional certification.
- Certified Coding Specialist certification.
- Registered Health Information Technician certification.
Responsibilities
- Complete initial medical record reviews within 24–48 hours of admission for an assigned patient population, evaluating documentation for principal and pertinent secondary diagnoses and procedures to support accurate DRG assignment, risk of mortality, and severity of illness.
- Conduct follow-up reviews every 2–3 days to support working DRG assignment.
- Formulate compliant provider queries when documentation is missing, unclear, or conflicting.
- Follow up daily with providers on open queries to ensure timely responses.
- Review final coding and DRG assignments and follow the DRG reconciliation process.
- Keep current with Official Coding and Reporting Guidelines, AHA Coding Clinics, CMS and other agency directives, and coding and CDI trends.
- Serve as a liaison between providers, clinical quality, and patient financial services.
- Educate providers to support the accuracy and integrity of the inpatient record.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
