OverviewThe Director of Clinical Documentation Integrity (CDI) provides enterprise-wide leadership for inpatient and ambulatory documentation integrity, including compliant query practices, standardized CDI workflows, and governance in partnership with Coding, Utilization Management (UM), Quality, and Compliance. This leader is accountable for operating a consistent CDI program that improves documentation quality, supports appropriate severity and risk capture (Medicare Severity Diagnosis-Related Groups (MS-DRGS) and Hierarchical Condition Categories (HCCs)), strengthens Case Mix Index (CMI) and audit defensibility, and reduces documentation-driven denials and rework. The Director partners with physicians, service line leaders, Case Management, and Revenue Cycle/Analytics teams to drive provider engagement, performance reporting, and enterprise-wide standardization.
QualificationsEducation- Bachelor's degree required (BSN)
- Master's preferred (in a related field)
Experience- Minimum of 5 to 7 years of progressive, direct experience as a CDI Specialist
- Minimum of 3 to 4 years of managerial, supervisory, or director-level experience, ideally within a large academic medical center or a complex medical hospital with proven team and talent development
License/Certification/Registration- CCDS (required)
- RN (Active)
- CCDS-O (preferred)
- CCS (preferred)
- CDIP (preferred)
- CDEO (preferred)
- CDEI (preferred)
- CRCR (preferred)
Other Qualifications- Cross-functional collaboration and conflict navigation
- Change leadership with continuous improvement mindset
- Executive-ready communication (written, verbal, facilitation)
- Strengthen influencing without authority in a matrixed health system environment
- Deep knowledge of Clinical Documentation Integrity (CDI) best practices and compliant query standards
- Comprehensive mastery of coding and DRG assignments, including both MS-DRG and APR-DRG methodologies and expertise in inpatient CDI workflows
- Strong reimbursement and coding acumen, including ICD-10-CM/PCS, Medicare Severity Diagnosis-Related Groups (MS-DRGs), and Case Mix Index (CMI) drivers
- Working knowledge of ambulatory documentation priorities, including E/M level selection and risk adjustment mechanisms such as Hierarchical Condition Categories (HCC) and risk capture
- The ability to impact and interpret hospital quality scores
- Practical working experience with Epic, combined with Iodine and Interact
- Ability to act as a trusted advisor to clinical departments and academic faculty, successfully coaching busy physicians and residents on compliant documentation
- Proven success in establishing a Center of Excellence by partnering with HIM and coding leadership to align training and quality assurance
- Documentation risk and audit-readiness knowledge, including denial themes and defensibility expectations
- Advanced analytical capability in trend analysis, root-cause thinking, and performance metric development/interpretation
