Job Category:Physician Provider
Work Shift/Schedule:8 Hr Morning - Afternoon
About the Role:Job SummaryThe Physician Advisor for Clinical Documentation Integrity (CDI) serves as a clinical subject matter expert responsible for promoting accurate, complete, and compliant medical record documentation. This role partners with CDI, coding, and medical staff to ensure documentation accurately reflects severity of illness, risk of mortality, and complexity of care, while supporting regulatory compliance, quality reporting, and appropriate reimbursement.
Minimum Job Qualifications- Licensure or other certifications: Hold an Active unrestricted medical license in the state of Georgia. Member of the NGHS medical staff. Board certification in a primary specialty
- Educational Requirements: Medical Degree, MD or DO
- Minimum Experience: Five (5) - seven (7) years physician practice experience. Demonstrated clinical practice experience
- Other:
Preferred Job Qualifications- Preferred Licensure or other certifications: CCDS, CDIP, or ACPA-C Medical License
- Preferred Educational Requirements:
- Preferred Experience: Prior Physician Advisor experience strongly preferred.
- Other:
Job Specific and Unique Knowledge, Skills and Abilities- Working knowledge of clinical documentation integrity, coding principles, and working knowledge of clinical documentation integrity, coding principles, and clinical validation
- Strong physician-to-physician communication and engagement skills
- Ability to perform secondary clinical reviews and provide defensible clinical validation for high-risk diagnoses (e.g., sepsis, respiratory failure, encephalopathy, AKI)
- Experience with physician education, query processes, and documentation improvement initiatives across multidisciplinary teams.
- Ability to interpret and apply coding guidelines (ICD-10-CM, CC/MCC capture) in a clinical context
- Familiarity with payer expectations and clinical validation denial trends
- Ability to analyze CDI data (e.g., CMI, query rates, denial trends) and translate into actionable improvement strategies
- Effective collaboration with CDI, coding, case management, and interdisciplinary teams
- Familiarity with utilization management principles and ability to provide cross-coverage support, including UM reviews
Essential Tasks and Responsibilities- Provide ongoing education to physicians on documentation best practices, including accurate diagnosis capture, severity of illness, and risk of mortality
- Deliver both formal presentations and targeted 1:1 education based on identified gaps and trends
- Serve as a physician-to-physician resource to drive engagement and accountability in documentation practices
- Perform secondary clinical reviews for complex, high-risk, or escalated CDI cases
- Provide clinical validation for diagnoses with high denial risk (e.g., sepsis, acute respiratory failure, encephalopathy, AKI)
- Ensure documentation accurately reflects patient acuity, clinical complexity, and resource utilization
- Support development and standardization of compliant query practices
- Review and provide guidance on complex, high-impact, or disputed queries
- Educate providers on appropriate query responses and documentation clarification
- Identify patterns in clinical validation denials and documentation vulnerabilities
- Collaborate with CDI, coding, and denials teams to reduce risk and improve defensibility
- Draft and support appeal letters for clinical validation and documentation-related denials
- Partner with CDI, Coding, Quality, and Case Management to align documentation practices across the organization
- Contribute to development of documentation guidelines, tip sheets, and educational resources
- Educate CDI specialists, RNs, and interdisciplinary staff on clinical documentation and validation principles
- Utilize CDI metrics (CMI, CC/MCC capture, query trends) to drive targeted improvement initiatives
- Provide cross-coverage for Physician Advisor functions as needed
- Perform utilization management (UM) reviews in support of operational needs and team coverage
- Participate in Medical Record Utilization Review (MR-UR) Committee and provide clinical input on documentation, medical necessity, and regulatory compliance
Physical Demands- Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
- Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
- Vision: Moderate, Frequently 31-65% of time
- Kneeling/Stooping/Bending: Occasionally 0-30%
- Standing/Walking: Occasionally 0-30%
- Pushing/Pulling: Occasionally 0-30%
- Intensity of Work: Frequently 31-65%
- Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving
