The Physician Advisor - CDI, Coding & Quality serves as a key clinical leader supporting Premier Health's goals to advance documentation accuracy, revenue integrity, and quality performance across the health system. This role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding, and Quality teams.
The Physician Advisor provides expert second-level reviews, leads provider education, and partners closely with the CDI Manager, Coding Manager and interdisciplinary teams to ensure that documentation accurately reflects the clinical complexity, severity of illness, and quality outcomes of Premier Health's patient population.
Key Responsibilities
1. Clinical Documentation Integrity (CDI) Leadership
• Provide secondary review of complex CDI and Coding queries escalated by the CDI and Coding teams.
• Review and resolve escalations involving Query disagreement, Clinical Validation, or incomplete response.
• Partner with the CDI Manager to establish standardized escalation criteria and ensure timely resolution of all high-impact queries.
• Conduct focused "second-look" reviews of no-CC/MCC or CC-only cases to identify missed documentation opportunities and support CMI improvement.
• Serve as a liaison between the CDI, Coding, and Physician teams to promote consistency in documentation practices.
2. Provider Engagement and Education
• Conduct one-on-one meetings with providers to review query metrics, patterns, and opportunities for improvement.
• Deliver targeted education sessions on documentation best practices, MCC/CC capture, and quality measure alignment.
• Participate in residency and faculty education (Internal Medicine, Family Practice, Trauma, Critical Care, etc.) including lectures and QIPS elective rotations on CDI and professional billing documentation.
• Partner with the CDI Manager and Quality leadership to develop and disseminate system-wide education tools and tip sheets.
3. CMI and Quality Improvement
• Analyze and communicate CMI trends by service line; support interventions to drive improvement aligned with Vizient benchmarks.
• Collaborate with Digital Health team to refine dashboards and enable data-driven improvement strategies.
• Participate in pre-claim mortality and risk adjustment reviews, focusing on REM score optimization and accurate capture of clinical risk variables.
• Support PSI/HAC reviews from a CDI perspective in partnership with Quality and CDI teams.
4. Interdisciplinary Collaboration
• Serve as a clinical resource to the CDI, Coding, and Quality departments on complex documentation and regulatory compliance questions.
• Partner with Digital Health to support AI-enabled CDI nudges, EHR workflow optimization, and system note-template refinement and creation for service lines.
• Contribute to system-wide initiatives related to mortality O/E, LOS O/E, and cost efficiency performance, Vizient facility ranking and Elix Hauser risk adjustment methodologies.
Performance Expectations
• Achieve a sizeable conversion rate on escalated CDI/Coding queries.
• Demonstrate measurable CMI improvement in targeted service lines.
• Support system improvement in key Vizient metrics (Mortality O/E, Cost O/E, LOS O/E).
• Maintain provider query agreement rate 60;80% and consistent educational engagement.
Qualifications
Education: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) required.
• Licensure: Active Ohio medical license (or eligibility for licensure).
• Experience:
- Minimum 3 years of clinical practice experience.
- Prior involvement in CDI, and or quality improvement preferred 1-2 years' experience
- Strong working knowledge of ICD-10, MS-DRG/APR-DRG systems, and risk adjustment models Vizient, CMS, Elixhauser etc.
• Skills:
- Excellent communication and teaching skills.
- Ability to interpret clinical and coding guidelines with precision.
- Proficiency with EHR systems (Epic experience preferred).
