Clinical Documentation Integrity Specialist – 2nd Level Reviewer

September 28

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Guidehouse

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Consulting • Digital Services • Public Sector

Guidehouse is a global consultancy offering advisory, digital, and managed services across commercial and public sectors. It is purpose-built to support industries such as national security, financial services, healthcare, energy, and infrastructure. Guidehouse collaborates with leaders to navigate complexity and drives transformational changes that impact the future. Their expertise spans data analytics, digital technologies, risk management, and more, with a strong emphasis on sustainability and innovation.

10,000+ employees

Founded 2018

💰 Grant on 2023-02

📋 Description

• Second level reviewer responsibilities include comprehensive, clinical chart reviews to ensure the most accurate reflection of the patient’s care and diagnosis following Official Coding Guidelines, Coding Clinics, and Client policies • Collaborate closely with the CDI team, Physician Advisors, Providers, Clinicians, Coding Educator, Coding Quality Auditors, Case Managers and Quality Department to assure documentation is clinically appropriate and accurately reflects severity of illness and risk of mortality • Applies ACDIS best practices for writing clinical documentation integrity clarifications and follows the CDI Code of Ethics • Collaborates with CDI Management/Educator to identify opportunities for education with CDI team, Coding, Providers and/or other ancillary staff • Participate in diverse projects and initiatives that enhance documentation quality and patient care standards • Responsible for comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification as well as potential coding opportunities • Acts as a liaison between the Coding Department and the Clinical Documentation Specialist to reconcile discrepancies in code and/or DRG assignment • Demonstrates excellent verbal and written communication skills for interactions with healthcare professionals and creation of compliant queries • Proficiently utilize EHR systems, CDI software, and encoders to optimize workflow and productivity • Analyze and interpret clinical data to identify gaps, inconsistencies, and/or opportunities for improvement and query the provider using concurrent query process following ACDIS/AHIMA Guidelines • Complete comprehensive secondary reviews of targeted patient populations including DRG/code discrepancies, mortality reviews, HACs, PSIs and other priority diagnoses • Consistently meet second level review productivity, quality, and turnaround expectations, including mailbox inquiries and mortality reviews • Document and track the results of secondary reviews and share information during formal and informal education sessions to stakeholders • Perform impartial audits of front-line CDI documentation using Guidehouse criteria, provide feedback and mentorship, and escalate unresolved disagreements • Participate in departmental and hospital committees, assigned task forces, and service line assignment meetings • Comply with HIPAA and code of conduct policies

🎯 Requirements

• Graduation from accredited School of Nursing with BSN, ADN OR Graduation from accredited medical school with MD or equivalent OR Bachelor’s or Master’s degree in health-related field • Currently licensed as a Registered Nurse, MD or MD equivalent OR Credentialed Medical Coder through AHIMA with current CCS, RHIA or RHIT credential and CDIP or CCDS • 4 + years previous relevant experience in clinical documentation, or CDI second level review or inpatient coding quality review and/or DRG validation • Strong understanding of disease processes, clinical indications and treatments; provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors • Solid understanding of hospital acquired conditions (HAC’s), patient safety indicators (PSI’s) and mortality models • Must maintain credentials while employed • Demonstrates excellent verbal and written communication skills • Proficient in utilizing EHR systems, CDI software, and encoders • Apply the principles of clinical validation and ensure that queries are compliant with AHIMA guidelines • Applies the Association of Clinical Documentation Integrity Specialist (ACDIS) best practices for writing clinical documentation integrity clarifications and follows the CDI Code of Ethics • Ability to collaborate with CDI Management/Educator, Physician Advisors, Providers, Clinicians, Coding Educator, Coding Quality Auditors, Case Managers and Quality Department • Strong clinical and critical thinking skillset (What Would Be Nice To Have) • CCDS or CDIP certification (What Would Be Nice To Have) • Experience with encoder and DRG assignments (MS and APR) (What Would Be Nice To Have) • Maintains working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system (What Would Be Nice To Have)

🏖️ Benefits

• Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. • Medical, Rx, Dental & Vision Insurance • Personal and Family Sick Time & Company Paid Holidays • Position may be eligible for a discretionary variable incentive bonus • Parental Leave • 401(k) Retirement Plan • Basic Life & Supplemental Life • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts • Short-Term & Long-Term Disability • Tuition Reimbursement, Personal Development & Learning Opportunities • Skills Development & Certifications • Employee Referral Program • Corporate Sponsored Events & Community Outreach • Emergency Back-Up Childcare Program