Clinical Documentation Integrity (CDI) Consultant - Remote

Overview

The Clinical Documentation Integrity (CDI) Consultant will provide timely reviews of patient medical records to ensure accurate and complete documentation to reflect the patient’s severity and complexity of illness. The CDI Consultant is expected to work with providers and coders to ensure that documentation on the chart reflects the complexity of the patient. The ability to educate and interact with providers is essential.

In Short

• Ensures inpatient clinical documentation accurately reflects severity of illness (SOI) and Risk of Mortality (ROM).
• Conducts regular audits to ensure compliance with documentation standards.
• Participates in education sessions for coders and hospital quality departments.
• Tracks data for quality reviews and escalates issues impacting documentation quality.
• Ensures compliance with CMS rules and regulations for coding.
• Familiar with OIG workplan to target education needs.
• Applies information related to coding changes affecting data quality.
• Strong analytical skills to evaluate medical records.
• Ability to communicate effectively with management and clients.
• Ability to use PC and Microsoft products for medical record review.

Requirements

• RN with BSN required.
• Iodine and APR experience required.
• 2+ years of clinical documentation experience.
• Strong clinical training experience.
• Second Level Review experience.
• 5+ years of acute care experience required.
• Ability to communicate effectively.
• Proficiency in Microsoft products.

Benefits

• Excellent salary and full benefits package.
• 401(k) with company match.
• Medical, dental, and vision insurance.
• Life, short/long term disability insurance.
• PTO policy.