Second Level Reviewer – Clinical Documentation Integrity

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $89k - $148k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Guidehouse

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

🏥 Healthcare

🎖️ Defense

📦 Logistics

💰 Grant on 2023-02

Healthcare • Defense • Logistics

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.

📋 Description

• Conduct comprehensive clinical chart reviews to ensure accurate reflection of patient care and diagnoses • Perform secondary reviews of targeted patient populations, including DRG/code discrepancies, mortality reviews, HACs, PSIs and priority diagnoses • Analyze clinical data to identify documentation gaps, inconsistencies and improvement opportunities • Query providers using the concurrent query process according to ACDIS/AHIMA compliant query-writing guidelines • Apply clinical validation principles and quality risk models during secondary reviews • Collaborate with CDI staff, Physician Advisors, providers, clinicians, coding educators, coding quality auditors, case managers and the Quality Department • Reconcile discrepancies in codes and/or DRG assignments between Coding and Clinical Documentation Specialists • Meet second-level review productivity, quality and turnaround expectations, including mailbox inquiries and mortality reviews • Collaborate with CDI educators and quality auditors to identify educational needs • Document and track secondary review results and share findings in education sessions • Perform impartial audits of frontline CDI documentation, provide feedback and mentorship, and escalate unresolved disagreements • Participate in departmental and hospital committees, task forces and service line meetings • Contribute to a positive and collaborative working environment • Perform other assigned duties • Comply with HIPAA and code of conduct policies

🎯 Requirements

• Requires a University Degree and minimum 4-6 years of prior relevant experience; relevant experience may be substituted for formal education or advanced degree • 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 • 4-6 years previous relevant experience in clinical documentation, CDI second level review, inpatient coding quality review and/or DRG validation • Strong understanding of disease processes, clinical indications and treatments • Understanding of provider documentation requirements for severity of illness, risk of mortality and diagnosis/procedure support for accurate clinical coding and billing • Knowledge of Medicare, Medicaid and commercial payor rules • Understanding of hospital acquired conditions (HACs), patient safety indicators (PSIs) and mortality models • Must maintain credentials while employed • Strong clinical and critical thinking skillset • Experience with encoder and DRG assignments (MS and APR) • Working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system • Excellent verbal and written communication skills • Proficiency with EHR systems, CDI software and encoders • Knowledge of ACDIS and AHIMA compliant query guidelines • Ability to quickly learn and adapt to new technologies • Must comply with HIPAA and code of conduct policies

🏖️ Benefits

• 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 • Flexible benefits package • Flexible work arrangements (remote)

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