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

University of Southern California • Los Angeles, CA

7d • $67 - $110

About The Position

The Senior Clinical Documentation Specialist Auditor performs inpatient medical record reviews 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, and knowledge of Inpatient Prospective Payment System documentation requirements for appropriate APR and MS-DRG assignment.

The auditor supports and leads the CDI team, engages with physicians and clinical staff, monitors CDI indicators related to revenue cycle and quality outcomes, and conducts strategic audits focused on denial prevention, quality comorbidities, risk adjustment, and quality assurance. The role also assists CDS staff with account reconciliation, denial management, provider education, documentation improvement, and coding accuracy. The auditor serves as a subject matter expert and consultant to providers, CDI and coding staff, and other departments, and may perform CDS duties when service demands require.

Keck Hospital of USC is a 343-bed acute care hospital providing specialized care for complex medical and surgical conditions. This position is full time, 8-hour days, and non-exempt.

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 team members as needed.
• Participate in the clinical denial and appeal process for DRG challenges and clinical validations; review technical payer denials, determine whether an appeal is justified, and author appeals.
• Perform audits for denial prevention, quality comorbidities, risk adjustment-related data, and quality assurance.
• Improve documentation through compliant physician query generation and provide education to providers and CDS staff.
• Achieve a 100% physician response rate through physician education, identification of non-responders, intervention, and use of the query escalation process.
• Use the MEAT (Monitored, Evaluated, Assessed or Treated) mnemonic to develop compliant, non-leading queries and apply evidence-based clinical criteria to validate diagnoses.
• Use CDI software to track metrics, document pertinent clinical findings and queries, complete required data-integrity fields, and communicate professionally with coders and other staff.
• Conduct retrospective reviews for mortality, quality metrics, payment denials, and other reasons as needed.
• Serve as a subject matter expert and resource for Clinical Documentation Specialists, coders, and other departments.
• When needed, assume 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 the Clinical Documentation Improvement Manager – Educator and Auditor, CDS Manager, and CDS Director on audit planning, development and execution, root-cause analysis, solutions, and education.
• Assist the Manager in accomplishing department goals and perform other duties as assigned.

What This Job Offers

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