CDI Reimbursement Manager - Medical College Physicians

The CDI Managing Liaison serves as a strategic partner within the Clinical Documentation Integrity (CDI) program, collaborating closely with Clinical Departments and CPS teams. This role advances the CDI mission by optimizing professional billing and reimbursement through the integration of frontend operations to reduce denials and revenue leakage.

Embedded within the CDI structure, the Managing Liaison works with department leadership, clinicians, revenue cycle partners, and ancillary services to identify and implement process improvements that enhance the overall revenue cycle experience. The role ensures documentation integrity, operational efficiency, and compliance with regulatory and billing standards while supporting accurate representation of the care delivered.

• Collaborate with Clinical Departments, CPS, and CDI leadership to identify and resolve clinical and financial concerns related to coding, documentation, charge capture, billing, and reimbursement.
• Evaluate opportunities to improve coding accuracy, documentation quality, and charge capture processes to ensure compliant and accurate reimbursement
• Coordinate and collaborate activities related to CDI, CPS, and Enterprise Registration for workflow improvement opportunities.
• Function as a process improvement liaison between CPS teams and clinicians, to improve tactics for seamless billing and collection processes.
• Analyze accounts receivable (AR) and financial reports, including monthly write-off reports, ad hoc reports, and physician logs, to identify trends, summarize outcomes, and track key performance indicators relevant to CDI initiatives.
• Monitor charge and payment report to ensure appropriate workflow for services rendered.
• Investigate and evolve follow up on encounters, coordinating with billing specialists and reimbursement teams to resolve discrepancies and ensure timely collections.
• Identify billing and reimbursement issues, develop improvement initiatives, and implement action plans to reduce write-offs and enhance revenue, supporting CDI-driven documentation improvement efforts.
• Provide ongoing training and education to clinicians, residents, and clinical support staff on professional billing practices, coding guidelines, documentation standards, use of modifiers, and payer policies, in collaboration with CDI.
• Support billing-related activities, including epic enhancements for accurate reimbursement, denials avoidance. Advise on cost and package in appropriate instances.
• Participate in billing meetings and committees to represent CDI and departmental interests, contributing to system-wide improvements.
• Lead and support special reimbursement projects as assigned in coordination with CDI initiatives.
• Prepare and support appeal creation and submission for denied claims, utilizing standard system reports and self-generated analyses in alignment with CDI documentation standards.
• Collaborate with CPS teams/leaders to maintain and enhance departmental policies and procedures related to complex or sensitive billing and reimbursement issues and ensure alignment with CDI protocols.
• Serve as the primary point-of-contact for department leaders and faculty regarding coding, billing, documentation, denials, reimbursement, and payer policies, under the CDI team's guidance with dissemination and connecting of CDI and CPS resources and support.
• Collaborate with CPS and others to ensure accurate charge capture setup for new services and CPT codes.
• Provide clinical coding support and education to coding, including evaluation of tools and resource deployment.
• Participate in new provider orientation to convey expected provider support available from CDI team.
• Share applicable provider tools and resources available that will optimize documentation practices and efficacies.
• Safeguard and strengthen relationships with internal and external stakeholders to support departmental financial health and CDI objectives.
• Perform other duties as assigned to support the overall goals of the department and organization.

• Comprehensive understanding of clinic operations, professional billing workflows, reimbursement practices, and revenue cycle management.
• Strong knowledge of procedure coding, CPT/HCPCS codes, use of modifiers, payer policies, and documentation standards.
• Working knowledge of insurance and managed care principles, including pre-authorizations, referrals, and payer requirements.
• Proficiency in electronic medical records (EMR)…