Second Level Reviewer – Clinical Documentation Integrity

🔥 14 hours 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 diagnosis • Apply Official Coding Guidelines, Coding Clinics, client policies, ACDIS best practices and the CDI Code of Ethics • 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 opportunities for improvement • Query providers using the concurrent query process under ACDIS/AHIMA compliant query-writing guidelines • Collaborate with CDI teams, Physician Advisors, providers, clinicians, Coding, Coding Educators, Coding Quality Auditors, Case Managers and Quality Department • Apply clinical validation principles and quality risk models during secondary reviews • Reconcile code and/or DRG assignment discrepancies as liaison between Coding and Clinical Documentation teams • Meet productivity, quality and turnaround expectations, including mailbox inquiries and mortality reviews • Collaborate with CDI educators and quality auditors to identify and address educational needs • Document and track secondary review results and share findings in education sessions • Conduct collaborative interactions with physicians and clinicians to improve understanding of CDI program goals • Perform impartial audits of front-line CDI documentation, provide feedback and mentorship, and escalate unresolved disagreements • Participate in committees, task forces and service line assignment meetings • Comply with HIPAA and code of conduct policies • Perform other duties as assigned

🎯 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 • 4-6 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, diagnoses/procedures, accurate clinical coding and billing • Knowledge of Medicare, Medicaid and commercial payor rules • Solid 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 • CCDS or CDIP certification • Demonstrated verbal and written communication skills • Proficiency with EHR systems, CDI software and encoders • Knowledge of ACDIS and AHIMA compliant query guidelines • Knowledge of CMS and other regulatory standards • Ability to quickly learn and adapt to new technologies

🏖️ 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