Senior Clinical Documentation Specialist Auditor - Clinical Doc Integrity - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

University of Southern California • Los Angeles, CA

6d

About The Position

The Senior Clinical Documentation Specialist Auditor reviews inpatient medical records to identify documentation opportunities that accurately represent severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics. The role requires proficiency in ICD-10-CM and PCS coding guidelines and regulations, expertise in CDI-related hospital quality metrics (including PSI, HACs, Vizient, and Elixhauser Comorbidities), and knowledge of IPPS documentation requirements for appropriate APR and MS-DRG assignment.

The Auditor works at an advanced level by leading and supporting the CDI team, engaging and educating physicians and clinical staff, monitoring CDI indicators tied to revenue-cycle and quality outcomes, and conducting targeted audits for denial prevention, quality comorbidities, risk adjustment, and quality assurance. The role also supports account reconciliation and denial management, advises providers and CDI and coding staff on documentation and coding, and collaborates with specialties to communicate changes.

The position supports daily team operations and training, participates in clinical denial and appeal work, evaluates payer denials, and prepares appeals when justified. It improves documentation through compliant, non-leading queries and education; applies evidence-based criteria for clinical validation; and uses CDI software to track metrics and maintain accurate, complete records. The Auditor may conduct retrospective reviews and may take on CDS duties as service needs require, including timely admission and follow-up reviews and working DRG updates. The role collaborates with CDI leadership on audits, root-cause analysis, solutions, education, and department goals.

Requirements

• Bachelor's degree.
• Graduate of an accredited school of registered nursing or foreign medical graduate.
• Three years of clinical documentation improvement experience.
• Three years of clinical experience in an acute care setting.
• Valid California Registered Nurse license or foreign medical graduate status.
• Certified Clinical Documentation Specialist (CCDS from ACDIS) or Certified Documentation Improvement Practitioner (CDIP from AHIMA).
• Fire Life Safety Training (LA City); if the card is not held upon hire, it must be obtained within 30 days of hire and maintained through renewal before expiration.

Nice To Haves

• Certified Coding Specialist (CCS) from AHIMA.

Responsibilities

• Direct and educate physicians, residents, and clinical staff on CDI processes and goals, working collegially with physicians, staff, and consultants.
• Support day-to-day team operations and help train new employees or assist other team members.
• Participate in clinical denial and appeal processes for DRG challenges and clinical validations, including reviewing payer denials, determining whether appeals are justified, and authoring appeals.
• Conduct assigned denial-prevention, quality-comorbidity, risk-adjustment, and quality-assurance audits.
• Improve documentation through compliant physician queries and education for providers and CDS staff.
• Achieve a 100% physician response rate through education, identifying non-responders, intervening as needed, and following the query escalation process when there is no response.
• Apply the MEAT (Monitored, Evaluated, Assessed or Treated) mnemonic when building compliant, non-leading CDI queries.
• Apply evidence-based clinical criteria to validate diagnoses.
• Use CDI software to track metrics, document pertinent clinical findings, record compliant queries, complete required data fields, and communicate professionally with coders and other staff.
• Conduct retrospective reviews for mortality, quality metrics, payment denials, or other reasons as needed.
• Serve as a subject matter expert and resource for CDS staff, coders, and other departments.
• When needed, perform CDS duties, including reviewing new inpatient admissions and assigning a working DRG within two working days, and conducting follow-up reviews and working DRG updates at least every two working days.
• Support and collaborate with CDI leadership on audit planning and execution, root-cause analysis, solutions, and education.
• Assist the Manager in accomplishing department goals and perform other duties as assigned.
• Assist CDS staff with account reconciliation to ensure complete coding and accurate documentation.
• Monitor CDI indicators associated with revenue-cycle and quality outcomes.
• Work with different specialties to keep them aware of changes.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior