Remote

As a Clinical Documentation Integrity Quality Reviewer, you will:
• Conduct retrospective and concurrent audits of clinical documentation reviews performed by CDI specialists to ensure compliance with organizational standards, coding guidelines, and regulatory requirements. Prepare audit reports, track key quality metrics, and present findings to CDI leadership and related stakeholders.
• Work closely with HIM, Coding, Compliance, Physician Advisory teams to resolve discrepancies related to MAHCs, PPCs, PSI, SOI/ROM and Mortality, and ensure cohesive clinical documentation practices.
• Develop and deliver targeted training sessions based on audit findings to address knowledge gaps and support CDI team competency. Provides ongoing education to CDI staff and physicians, and clinical teams to enhance knowledge of documentation standards and practices.
• Oversee the accuracy, specificity, and completeness of clinical documentation to support compliance, quality care, and proper reimbursement.
• Collaborate with CDI leadership to recommend quality improvement initiatives, update audit tools, refine CDI workflows, and ensure all documentation aligns with regulatory requirements, such as CMS guidelines, HIPAA, and organizational policies.
• Analyze findings, identify trends in documentation and coding practices, and provide detailed feedback to CDI team members to support professional development.

Qualifications include:
• Doctor of Medicine (MD), Doctor of Osteopathy (DO), Foreign Medical Graduate (FMG), or Registered Nurse (RN)
• RHIA, RHIT, or related clinical/allied health degree
• Minimum of 5 years inpatient clinical experience
• 2+ years of clinical documentation, coding, case management, utilization review, or acute-care clinical experience
• Experience interpreting physician documentation, lab results, imaging, and clinical indicators.
• Experience with ICD-10-CM/PCS, DRGs, SOI/ROM or HCC is a plus
• Lean Six Sigma Green belt preferred
• Solventum360 preferred
• CCDS (Certified Clinical Documentation Specialist), CDIP (Clinical Documentation Improvement Practitioner) or equivalent required
• Certified Documentation Expert Inpatient (CDEI) preferred
• Certified Coding Specialist (CCS) preferred
• Strong skills to effectively manage and guide CDI teams while fostering collaboration and performance excellence.
• Good understanding of medical terminology, disease processes, and clinical practices to ensure documentation quality.
• Proficiency in ICD-10-CM/PCS and CPT coding systems, along with coding guidelines and standards.
• Familiarity with healthcare compliance requirements, including CMS, HIPAA, and Joint Commission standards.
• Ability to analyze complex documentation issues and implement practical, effective solutions.
• Strong verbal and written communication skills to engage with healthcare providers, coders, and team members effectively.
• Capability to manage workflows, set priorities, and ensure timely completion of documentation reviews.
• Adept at training CDI specialists and clinical staff on documentation best practices and standards.
• Ability to build rapport and maintain collaborative relationships across interdisciplinary teams.
• Familiarity with electronic health records (EHR) systems, CDI tools, and other healthcare technologies

Work Schedule:

• Employment Type: Full-time

• Hours per Week: 40 hours

• Typical Daily Schedule: Monday through Friday 

• Shift Type: Day Shift

• Weekend Requirements: No Weekends

• Competitive Performance Incentive: Eligible

Pay Range:

$83,112.12 - $124,675.20

If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.

Under the Fair Labor Standards Act (FLSA), this position is classified as:

United States of America (Exempt)

At Adventist HealthCare our job is to care for you.

We do this by offering:

• Work life balance through nonrotating shifts

• Recognition and rewards for professional expertise

• Free Employee parking

• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire

• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)

• Paid Time Off

• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period 

• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance

• Subsidized childcare at participating childcare centers

• Tuition Reimbursement

• Employee Assistance Program (EAP) support