CDI Auditor

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Conducts audits of Clinical Documentation Integrity Specialists' work, including CDI reviews, interim coding, DRG matches, compliant queries, and identification of appropriate query opportunities. Performs as a subject matter expert in CDI best practices in CDI activities.

Minimum Specifications

Education

- Must have a Bachelors Degree in Nursing from an accredited college or university or a graduate of a Health Information Management program or Medical School graduate with a Masters Degree in a Healthcare/Medical related field from a United States accredited university

Experience

- Must have five years of experience in a hospital as a CDI Specialist with two years completing quality reviews and/or audits of CDI activities

Certification/Registration/Licensure

- Must have one of the following current certifications: Certified Clinical Documentation Specialist (CCDS) or Certified Clinical Documentation Improvement Practitioner (CDIP).

- For RNs: Must have a current RN license or valid temporary permit with the Texas Board of Nursing; or valid compact RN license.

- For HIM Professionals: Must have one of the following current certifications: Certified Coding Specialist (CCS) Registered Health Information Technologist (RHIT) Registered Health Administrator (RHIA) AHIMA Approved ICD-10 Trainer (or ability to obtain w/in 6 months of hire)

Required Tests for Placement

- HIM professional must score a minimum of 85% on a pre-employment coding test.

Skills or Special Abilities

- Must demonstrate a basic understanding of the MS-DRG system, CC/MCC's, impact on quality and - CMI as well as ICD-10 coding systems and how the guidelines relate to Clinical Documentation Improvement

- Must demonstrate advanced clinical knowledge of medical terminology, disease process and pharmacology

- Must score a minimum of 85% on a pre-employment coding test, if an HIM Professional

- Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles and methodologies (MS-DRG and APC).

- Must have a working knowledge of the compliance guidelines related to coding and billing

- Must have strong skills in diplomacy, professionalism and trustworthiness

- Must be able to demonstrate time management, organizational, oral and written communication skills

- Must be able to demonstrate excellent computer skills, including word processing, spreadsheet and database management software proficiency.

Responsibilities

1. Conducts CDI Quality audits for appropriate capture of clinical findings, reviews, daily query follow-up and escalation processes, as well as query content. Determines if codes are correctly revised based on query responses.

2. Conducts coding assessment to include consistency of working DRG with current chart documentation, accurate ICD-10 code assignment in accordance with the following: Official Coding Guidelines, as published in AHA Coding Clinic and AMA CPT Assistant, hospital policies, specific payer guidelines, rules, and regulations.

3. Reviews to ensure queries are in accordance with the Guidelines for Achieving Compliant Query Practice.

4. Analyzes documentation to ensure missed query opportunities are identified.

5. Provides feedback to the CDI staff on findings as needed. Provides reports of findings to the Coding Quality Manager, HIM Education Manager, and the Clinical Documentation Integrity Manager.

6. Utilizes external data and analysis reporting tools to identify trends and any areas of opportunity

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.