Lead Clinical Documentation Improvement and Reimbursement Specialist

1 month ago


Cambridge, Massachusetts, United States Mass General Brigham Full time

About the Role

We are seeking a skilled Lead Clinical Documentation Improvement and Reimbursement Specialist to join our team in post-acute care. This role will be responsible for facilitating improvement in the overall quality, completeness, and accuracy of medical record documentation.

Key Responsibilities

  1. Provides education to the CDI team on documentation requirements and notifies the team of coding/billing updates as needed.
  2. Assists the CDI team with validation of clinical review and development of compliant physician queries.
  3. Maintains and develops Compliant Physician Query Templates located in the Electronic Health Record.
  4. Reviews inpatient medical records within 24-48 hours of admission and throughout hospitalization to evaluate documentation supporting coders' assignments.
  5. Conducts concurrent follow-up reviews of patients every 2-3 days to support and assign additional diagnoses that may impact length of stay.
  6. Queries physicians regarding missing, unclear, or conflicting medical record documentation by requesting and obtaining additional documentation within the medical record as applicable.
  7. Collaborates with case managers, nursing staff, and other ancillary staff regarding interaction with physicians on documentation and to resolve physician queries prior to patient discharge.

Qualifications and Experience

  • Experience working in post-acute care (IRF preferred, SNF or LTCH).
  • Graduate of an accredited School of Nursing.
  • Current licensure from the Massachusetts Board of Registration to practice professional nursing.
  • Certificate in Case Management or Clinical Documentation Improvement (CDIP) preferred.
  • Minimum of 5 years experience in either clinical nursing, case management, HIM inpatient coding, or an equivalent combination of these disciplines.
  • Knowledge of acute regulatory/accreditation requirements preferred.
  • Basic knowledge of coding/classification systems appropriate for inpatient CMG and DRG prospective payment system.
  • Computer proficiency required.

About the Position

This is a full-time position with a competitive salary range of $85,000-$110,000 per year, depending on experience, and a comprehensive benefits package. The ideal candidate will have excellent communication and interpersonal skills, with the ability to work effectively in a team environment. If you are a motivated and detail-oriented individual with a passion for improving patient outcomes, we encourage you to apply for this exciting opportunity.



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