Guidehouse Remote - Clinical Documentation Integrity (CDI) Specialist - 2nd Level Reviewer in Albany, New York
Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.
Second level reviewer responsibilities include comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, act as a liaison between coding and CDI to resolve DRG or other code discrepancies, collaborate with CDI educator to educate CDI team based on opportunities identified in second level reviews and work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and/or provider education. The Clinical Documentation Integrity Second Level Reviewer will collaborate closely with Coders, Coding Educators, Coding Quality Auditors, Case managers, Quality Department and Providers to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards.
Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for Compliant Query Writing.
Complete comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and/or code discrepancies; mortality reviews to ensure documentation supports risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnosis as identified by UAB for potential missed opportunities to clarify documentation or clinically validate a diagnosis.
Acts as a liaison between the Coding Department and the Clinical Documentation Specialist to reconcile discrepancies in code and/or DRG assignment
Communicates findings of secondary reviews to respective Clinical Documentation Specialist for follow-up and query initiation.
Collaborates with CDI educator/quality auditor when educational needs are identified from second level reviews
Documents and tracks second level reviews and results. Shares this information with staff at monthly CDI team meeting.
Collaborative interaction with physicians and/or other clinicians to enhance understanding of the CDI program goals; ensure the medical record can be coded accurately in order to accurately reflect patient severity of illness and risk of mortality
Collaborates with other clinical disciplines (i.e. quality, case management etc.) and members of the coding department to ensure high quality clinical documentation and efficient, timely coding of the medical record.
Participates in performance improvement activities related to the operational processes for the Documentation Integrity Program as well as related organizational/departmental goals.
Develops collaborative relationships and promotes team- work with co-workers and other departments.
Subject matter expert for CDI Concurrent Review Teams.
Performs other duties as assigned.
Graduation from accredited School of Nursing; BSN or Bachelor’s degree in health related field and/or Masters required OR
Graduation from accredited medical school; MD or DO required
Minimum of five (5) years as a Clinical Documentation Integrity Specialist required. Minimum of five (5) years as an RN required.
Exhibits strong clinical, critical thinking skillset
Experienced Clinical Documentation Integrity Specialist (minimum 5 years) or CDI Second Level Reviewer with a strong understanding of disease processes, clinical indications and treatments; provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors as well as a solid understanding of hospital acquired conditions (HAC’s) , patient safety indicators (PSI’s) and mortality models.
Experience with encoder and DRG assignments (MS and APR)
Maintains working knowledge of official knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system
Excellent communication skills, with ability to listen and understand client request and needs while employing tact and effectiveness
Ability to conduct meaningful conversations and /or presentations with providers in all situations
Currently licensed or licensed by endorsement as a Registered Nurse, MD or MD equivalent or credentialed coder with current CCS credential.
CCDS or CDIP Certification required.
Must maintain credentials while employed
CCS preferred (exception required by coder)
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
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 and Adoption Assistance
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
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