CDI Auditor

Job Description

Job Description

Description:

At e4health, we Empower Better Health. The e4health Team is on a relentless mission to care for those teams who care for others. We bring our passion, ingenuity, and expertise to every engagement. In joining our Team, we want your help to provide our customers with powerful solutions in the pursuit of quality, integrity, clinical and financial value across healthcare.

Our People make the difference. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. e4health solutions streamline clinical, financial, and health information data and workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at

The Clinical Documentation Integrity (CDI) Auditor is responsible for completing quality assurance reviews of patient medical records to ensure accurate and complete documentation to reflect the patient’s severity and complexity of illness. The CDI Auditor will audit records previously reviewed by Customer CDS consultants. The chart will be reviewed for missed opportunities to capture greater specificity or clarify inconsistencies in the clinical picture of the patient. Queries posed by the Customer CDS will be reviewed from a compliance perspective, utilizing ACDIS/AHIMA Practice Brief (2022) as the standard. Adherence to Customer specific CDI processes or procedures may also be reviewed. The CDI Auditor may also review accounts not previously reviewed by Customer CDS to identify opportunities for improvement. The CDI Auditor will work within Customer systems and e4health Audit software to identify areas of risk, documentation opportunities, identifiable trends, and assist with report writing as appropriate. This position is expected to interact with the Customer appropriately and other team members.

• Review medical records as assigned for complete and accurate documentation of all relevant diagnoses and procedures
• Identify missed documentation opportunities within medical records as previously reviewed or not reviewed by Customer CDI team
• Evaluate queries from a compliance perspective to determine if there are any areas of risk, using ACDIS/AHIMA Practice Brief as the standard
• Assess adherence to Customer specific CDI processes/procedures
• Adhere to guidelines as set forth by ACDIS, AAPC, and AHIMA
• Demonstrate understanding of the business of healthcare: MS and APR DRG payer issues, audit risks, documentation opportunities, POA, quality metrics, hierarchical condition categories, and various risk adjustment methodologies
• Work closely with the Customer, co-workers, and management to meet the specific needs of each assignment in alignment with core values
• Effectively utilize computer software based on the specific Customer requirements
• Maintain strict confidentiality of all patient information in accordance with HIPAA

BENEFITS:

We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long-term disability insurance, and PTO policy.

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS:

Sitting, talking, hearing and near vision are required over 90% of the time. Feeling is required over 90% of the time and reaching is required about 50% of the time. The ability to travel to field sites may be required up to 15% of the time.

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS:

Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present only in unusual situations.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position.

REQUIRED QUALIFICATIONS:

• Candidate must possess current ACDIS CCDS or AHIMA CDIP certification
• Candidate must possess current RN License
• 3+ years of clinical documentation improvement experience required with an acute care facility required
• 2+ years of CDI auditing experience
• Thorough understanding of both MS and APR DRG methodologies and Compliant Query Practices as outlined by ACDIS/AHIMA
• Strong analytical skills to clinically evaluate the medical record
• Ability to independently use multiple computer applications for medical record review along with proficiency utilizing Microsoft products (Excel, Word, Outlook)
• Ability to communicate effectively with e4health management and Customers
• Proficiency with ICD-10-CM and ICD-10-PCS

PREFERRED QUALIFICATIONS:

• Coding credentials such as CCS is preferred
• BSN, in addition to RN license is preferred
• Experience with multiple health facilities, multiple electronic medical records, and multiple encoders strongly preferred
• Familiarity with various risk models strongly preferred
• Understand of HAC/PSI models, including exclusionary opportunity is preferred