Position SummaryThe CDI Specialist Level I is responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate if clinical documentation is reflective of medical necessity, quality of care outcomes and reimbursement compliance for acute care services provided. Works closely with the medical staff to facilitate appropriate clinical documentation of patient care. Other responsibilities include conducting initial and extended-stay concurrent reviews on all selected admissions and documenting findings.
Required Qualifications- Medical Graduate, Physician Assistant or Registered Nurse (Current CA License)
- Ability to multitask and maintain a work pace appropriate to workload
- Must demonstrate customer service skills appropriate to the job
- Excellent written and verbal communication skills in English
- Ability to effectively communicate with physicians in a clear and concise manner
- Computer literacy and proficiency
- Hospital Fire and Life Safety Card (Los Angeles City Employees only)
Preferred Qualifications- Experience in US acute care hospital setting
- Previous experience working as CDI
Physical RequirementsThese are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable, state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation.
- Standing - Frequently
- Walking - Frequently
- Sitting - Frequently
- Reaching with Hands and Arms - Occasionally
- Climb or Balance - Occasionally
- Stooping, Kneeling, Crouching, or Crawling - Occasionally
- Talking - Frequently
- Hearing - Constantly
- Seeing - Constantly
- Performing repetitive motions with arms or hands - Frequently
- Lifting, carrying, pushing or pulling up to 10 lbs - Constantly
- Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally
- Lifting, carrying, pushing or pulling up to 50 lbs - None
- Lifting, carrying, pushing, or pulling greater than 50 lbs - None
- Driving - None
Essential Job FunctionsThe essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position.
- Reviews inpatient medical records, meeting all department productivity goals, for identified payor populations as directed on admission and throughout hospitalization and identifies potential gaps in physician documentation. Ensures that clinical documentation reflects the level of service rendered to patients in a complete, accurate and compliant manner.
- Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process, meeting department productivity goals. Follows up with the physicians to get resolution of all queries prior to patient's discharge to ensure accurate quality data and appropriate reimbursement whilst maintaining up to date DRG. Assists coders in follow-up on queries and clarifications to physicians done retrospectively post patient discharge.
- Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through comprehensive auditing and evaluation of the medical record. Collects and analyzes data to provide reports and make recommendations. Works collaboratively with Performance Improvement Department to improve clinical documentation for compliance in quality of care measures.
- Performs the duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and all regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
- Reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician. Follow-up in improving clinical documentation to reduce such denials. Works collaboratively with health information management coding staff, physicians and financial services to resolve payment denials and documentation issues.
- Regularly participates in scheduled case management meetings and actively exchanges information pertaining to clinical documentation, plan of care affecting coding and reimbursement. Educates others on documentation guidelines on an ongoing basis.
Pay Rate: Min - $87,200 l Max - $119,900 
