CDI Auditor

Job Description

Description:

Clinical Documentation Integrity Quality Auditor

JOB SUMMARY:

The Clinical Documentation Integrity Quality Auditor is responsible for completing quality assurance reviews of patient medical records to ensure accurate and complete documentation to reflect the patient’s severity and complexity of illness. The Clinical Documentation Integrity Quality Auditor will audit records previously reviewed by Customer CDS consultants. The chart will be reviewed for missed opportunities to capture greater specificity or clarify inconsistencies in the clinical picture of the patient. Queries posed by the Customer CDS will be reviewed from a compliance perspective, utilizing ACDIS/AHIMA Practice Brief (2022) as the standard. Adherence to Customer specific CDI processes or procedures may also be reviewed. The Validation Consultant may also review accounts not previously reviewed by Customer CDS to identify opportunities for improvement. The Validation Consultant will work within Customer systems and e4health Audit software to identify areas of risk, documentation opportunities, and identifiable trends, and assist with report writing as appropriate. This position is expected to interact with the Customer appropriately and other team members.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Review medical records as assigned for complete and accurate documentation of all relevant diagnoses and procedures

Identify missed documentation opportunities within medical records as previously reviewed or not reviewed by Customer CDI team

Evaluate queries from a compliance perspective to determine if there are any areas of risk, using ACDIS/AHIMA Practice Brief as the standard

Assess adherence to Customer specific CDI processes/procedures

Adhere to guidelines as set forth by ACDIS, AAPC, and AHIMA

Demonstrate understanding of the business of healthcare: MS and APR DRG payer issues, audit risks, documentation opportunities, POA, quality metrics, hierarchical condition categories, and various risk adjustment methodologies

Work closely with the Customer, co-workers, and management to meet the specific needs of each assignment in alignment with core values

Effectively utilize computer software based on the specific Customer requirements

Maintain strict confidentiality of all patient information in accordance with HIPAA

BENEFITS:

We offer an excellent salary, full benefits package including 401(k) with company match and discretionary profit sharing, group medical, dental, vision, life, & short-term disability insurance, and PTO policy

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS:

Sitting, talking, hearing and near vision are required over 90% of the time, while walking is required frequently throughout the day. Standing is required over 10% of the time. Feeling is required 90% of the time and reaching is required about 50% of the time. Bending, twisting and climbing are required, as in far vision, but only for 10% or less of the time. Low levels of lifting (10 pounds of less) is required about 25% of the time, while medium levels (20 to 40 pounds) of lifting and carrying are required less than 5% of the time. Ability to travel to field sites may be required up to 15% of the time.

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS:

Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present in only unusual situations.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

Applicants for U.S. based positions with e4healtRequirements:

REQUIRED QUALIFICATIONS:

Candidate must possess current ACDIS CCDS or AHIMA CDIP certification

5+ years of clinical documentation experience required with an acute care facility required

2+ years of CDI auditing experience

Current RN license or graduate of medical school with 5+ years of acute care experience preferred; some Customers may require RN

Minimum 2 years of remote experience required

Thorough understanding of both MS and APR DRG methodologies and Compliant Query Practices as outlined by ACDIS/AHIMA

Strong analytical skills to clinically evaluate the medical record

Ability to independently use multiple computer applications for medical record review along with proficiency utilizing Microsoft products (Excel, Word, Outlook)

Ability to communicate effectively with e4health management and Customers

Proficiency with ICD-10-CM and ICD-10-PCS

PREFERRED QUALIFICATIONS:

Coding credentials such as CCS is preferred

BSN, in addition to RN license is preferred

Experience with multiple health facilities, multiple electronic medical records, and multiple encoders is strongly preferred

Familiarity with various risk models is strongly preferred

Understanding of HAC/PSI models, including exclusionary opportunity is preferred

KEY SUCCESS ATTRIBUTES:?

Integrity, passion, and ethics are required

Demonstrates strong collaboration skills

Has strong organizational, analytic and problem-solving abilities and techniques

Exhibit consistent initiative with strong drive for results and success

Demonstrate commitment to a team environment?

Demonstrate excellent interpersonal as well as well-developed written, verbal, and presentation communication skills including deep listening and attention to detail

Ability to self-motivate and self-direct

Possess strong time management and organizational skills

Commitment and adherence to company Core Value

CORE COMPETENCIES:

Communication

High level of integrity & ethical judgement

Consistency and Reliability

Meeting Standards

Full-time

Fully remote