Clinical Documentation Integrity Auditor CDI

Why Work at Children’s….

Here, it’s different. Come join us.

Children’s Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation’s brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist’s outlook, a trailblazing spirit, and a celebrated history, we’re making new strides every day.

We’ve been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report.

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties.

Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat.

That’s why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through our doors.

A career at Children’s Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it’s different.

Job Overview

The Clinical Documentation Integrity (CDI) Auditor is responsible for the overall quality, completeness, and accuracy of the medical record documentation through extensive audit review, clinical criteria research, drafting of appeals, and data trending. Internal auditing for the CDI program will ensure compliance, quality, denial trends, and educational opportunities are identified and solved in partnership with CDI leadership. Responsible for the review, appeal, and tracking of DRG denials received through government audits and/or commercial payers. Strong aptitude for quickly troubleshooting and identifying the cause of questionable results within abstracts and reports. Works in association with the CDI staff, clinicians, coders, and all members of the healthcare team to ensure accurate and timely clinical documentation in the medical record.

Additional Information

Department Name: Health Information Management

Job Status: Full time, 40 hours per week

Shift: Day Shift

Fully Remote

Qualifications

• EDUCATION – A ssociate Degree in Nursing .
• EXPERIENCE – Three (3) years of experience to include: one (1) year of experience within Clinical Documentation Integrity in the inpatient acute care setting and one (2) years of experience as a clinical nurse in an inpatient acute care setting.
• EQUIVALENCY – None.
• CERTIFICATION(S) – Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) is required.
• LICENSURE – Active Registered Nurse licensure is required.
  
  

Responsibilities

POPULATION SPECIFIC CARE

No direct patient care.

Essential Functions

An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.

• Manages the DRG denial and appeal process for CDI. Reviews DRG denial cases received from government audits and/or commercial payers.Research case content and denial rationale. Draft appeal letters with relevant citations from the clinical chart and appropriate clinical references to support argument. Ensure timely submission of appeals through the appropriate workflows.
• Track volumes, trends, outcomes, and other pertinent data elements needed to measure the success and/or identify continued risk to the organization for future denials and recoupment of funds.
• Collaborates with CDI Manager and CDI Educator to review trends related to denials, query activity, and revenue cycle opportunities to inform educational content and strategic planning for CDI, HIM Coding, or Provider audiences. Develops and delivers educational materials and presentations to individuals and/or group settings.
• Develops library of appeal templates to streamline efficiency of the denial review and appeal process.
• Performs second-level audits of CDI reviews and queries to ensure compliant practice, identify educational topics, and opportunities for workflow or technology optimization. Synthesizes findings to provide recommendations to ensure CDI program growth and compliance with hospital policy, medical staff by-laws and regulatory and legal requirements, and departmental policies and procedures.
• Conducts advanced CDI chart reviews based on DRGs and care site-specific trends to identify gaps in documentation and training opportunities. Provides clinical subject matter expertise in reviewing cases identified through internal processes to appropriate stakeholders.
• Supports the coordination of internal CDI team and/or HIM departmental projects to support the organizational pillar goals and advancement of the CDI program with national best practice standards.
• Acts as a coding and clinical documentation resource for hospital based and contracted physicians.
• Maintains subject matter expertise within CDI, Coding, and Quality.
  
  

Other Information

SCOPE AND LEVEL

• Guidelines: Guidelines are generally but not always clearly applicable, requiring the employee to exercise judgment in selecting the most pertinent guideline, interpret precedents, adapt standard practices to differing situations, and recommend alternative actions in situations without precedent.
• Complexity: Duties assigned are generally complex and may be of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects in various stages of completion.
• Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed.
• Communications: Contacts with team members, clients or the public where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function.
• Supervision Received: Performs work with minimal supervisory oversight. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work is reviewed for adherence to instructions, accuracy, completeness, and conformance to standard practice or precedent. Recurring work clearly covered by guidelines may or may not be reviewed.
  
  

Physical Requirements

Ability to Perform Essential Functions of the Job

Physical Requirements

• Audio-Visual: Color Discrimination – Fair
• Audio-Visual: Depth Perception – Fair
• Audio-Visual: Near Vision: Good
• Audio-Visual: Far Vision: Good
• Audio Visual: Hearing: Good
• Motion: Bend : Up to 1/3 of the time
• Motion: Reach up to 1/3 of the time
• Motion: Carry up to 1/3 of the time
• Motion: Pull up to 1/3 of the time
• Motion: Push up to 1/3 of the time
• Weight Lifted/Force Exerted: Up to 10 lbs. or more of the time
• General Activity: Stand/Walk up to 4hrs a day
• Use of hands/feet: Precise Motion Function (or fine manipulation)
  
  

WORK ENVIRONMENT

• Exposure: Exposure to blood/body fluid: Occasional
• Exposure: Exposure to cold/heat: Occasional
• Exposure: Exposure to infectious disease: Occasional
• Mental and Emotional Requirements: Manages stress appropriately
• Mental and Emotional Requirements: Works with other effectively
• Mental and Emotional Requirements: Handles multiple priorities effectively.
• Mental and Emotional Requirements: Independent discretion/decision making.
• Mental and Emotional Requirements: Makes decisions under pressure.
• Mental Stress: multi-tasking, meeting deadlines, prioritizing
  
  

Equal Employment Opportunity

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.

Salary Information

Annual Salary Range (Based on 40 hours worked per week): $82,095.81 to $123,143.72

Hourly Salary Range: $39.47 to $59.20

Benefits Information

Here, you matter. As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children’s Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children’s Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.