RN - Clinical Documentation Integrity Specialist

Overview

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 we needed or requested. Reviews DRG denials and provides information to the denials team related to appealing the encounter. Supports appropriate coding, and meets coding guidelines, regulatory and organizational standards.

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 we needed or requested. Reviews DRG denials and provides information to the denials team related to appealing the encounter. Supports appropriate coding, and meets coding guidelines, regulatory and organizational standards.

Certifications:

Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR);
Certified Clinical Documentation Specialist (CCDS) within 1 year
- Association of Clinical Documentation Integrity Specialists (ACDIS);
Certified Coding Specialist (CCS) within 1 year
- American Health Information Management Association (AHIMA);
Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA);
Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA);
Licensed Physician (MD) - Illinois Department of Financial and Professional Regulation (IDFPR),

Education:

Doctorate:
Medicine;
College Diploma:
Health Information Mgt;
College Diploma:
Nursing,

Work Experience:

CDI;
Coding;
Clinical bedside

Conducts comprehensive, concurrent and retrospective reviews of inpatient accounts to evaluate documentation accuracy and clinical validity. To identify missing, unclear, or conflicting documentation that impacts DRG assignment, SOI/ROM, mortality, PSI, quality metrics, and clinical outcomes. Strong knowledge of ICD-10 guidelines, electronic health record (EHR) systems, and excellent communication skills to interact with physicians. Develop and issue compliant, clinically supported physician queries to clarify diagnoses, clinical indicators, or treatment plans.

CDI specialist will serve as subject matter experts providing guidance and training to providers and clinicians related to DRG and documentation opportunities. Supports organizational initiatives related to quality reporting, CDI program development, and regulatory compliance. Participates in audits, data validation, and performance projects. Maintain advanced knowledge of clinical guidelines, coding updates and CDI best practices. Utilizes clinical knowledge and coding guidelines to support documentation efforts.

Uses EPIC scoring tools, meets production standards, follows up on open queries according to established turnaround times. Attends mandatory and regular education sessions as needed. Follows appropriate workflow in EPIC and CDI software and notifies one up leader of any issues. May serve as an "expert" and participate in testing for upgrades as needed. Maintains educational hours needed to re-certify credentials.

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