HIM Clin Doc Integrity Specialist - CFH

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Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which impacts Case Mix Index and mortality ratings. Coordinates with physicians, nurses, ancillary staff, and the coders in Health Information Management to identify and record principal and secondary diagnoses, principal procedures, and assign the working DRG.

Performs second level review of specific DRGs as assigned. Presents education related to CDI topics to peers and providers as requested. Reviews DRG denials and provides information to the denials team related to appealing the encounter.

• Conducts the initial concurrent review process for all selected admissions.
• Clarifies documentation in the medical record as appropriate through communication with the physicians, nurses, and ancillary staff.
• Assures documentation in the chart represents a true clinical picture of the patient diagnoses and supports care that was given and DRG assigned.
• Documents findings within Carle CDI software and updates software as required to reflect the status of the encounter and any follow‑up.
• Coordinates with the physicians, nurses, ancillary hospital staff, and Health Information Management Department’s coding staff to identify and record principal and secondary diagnoses, principal procedures, and assign the working DRG.
• Follows query process and escalates as necessary.
• Conducts education related to CDI topics to peers and providers as needed or requested.
• Performs second level review on selected inpatient encounters.
• Reviews denials for accurate and complete documentation and develops an appeal letter when needed.
• Attends mandatory and regular education sessions as needed.
• Follows appropriate workflow in EPIC and CDI software and notifies a leadership point‑of‑contact of any issues.
• May serve as an "expert" and participate in testing for upgrades as needed.

• Registered Health Information Administrator (RHIA) – American Health Information Management Association (AHIMA).
• Registered Professional Nurse (RN) – Illinois Department of Financial and Professional Regulation (IDFPR).
• Associate’s Degree in a related field.
• Work experience in CDI, clinical bedside.

Full‑time

Entry level

Health Care Provider

The compensation range for this position is $34.31 per hour – $59.01 per hour. This represents a good‑faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered to a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked, and compensation model.

Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E‑Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee’s Form I‑9 to confirm work authorization.