About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.聽
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. 聽
JOB SUMMARY:
The CDI Reconciliation Auditor is responsible for performing detailed quality reviews and reconciliations of clinical documentation and coding outcomes, with a focus on DRG (Diagnosis-Related Group) validation and Physician Audit reviews. This role ensures that documentation supports accurate coding and billing practices, in compliance with regulatory and payer requirements.ESSENTIAL DUTIES AND RESPONSIBILITIES:聽
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member鈥檚 performance objectives as outlined by the Team Member鈥檚 immediate Leadership Team Member.
Conduct reconciliations of CDI and coding outcomes to ensure alignment with final DRG assignments.
Review discrepancies between CDI specialists and coders, resolving variances to support accurate claim submission.
Perform quality audits on Physician Audit reviews to validate the appropriateness of coding and documentation.
Ensure clinical documentation meets regulatory standards, payer guidelines, and organizational policies.
Identify trends and patterns in documentation and coding errors, providing feedback and education to CDI and coding teams.
Collaborate with internal teams to develop and implement process improvements based on audit findings.
Provide education and training to CDI and coding staff on reconciliation outcomes and audit findings.
Serve as a liaison between CDI specialists, coders, and physicians to resolve documentation and coding queries.
Maintain up-to-date knowledge of coding guidelines (ICD-10, CPT, etc.), payer policies, and regulatory requirements.
Prepare and present regular reports on reconciliation and audit outcomes, including key metrics and recommendations.
Bachelor鈥檚 degree in Nursing, Health Information Management, or a related field; or equivalent clinical experience.
3-5 years of experience in CDI, coding, or clinical auditing roles.
Strong background in DRG validation and Physician Audit processes.
Experience with healthcare coding systems and standards (ICD-10, CPT, HCPCS).
Certified Clinical Documentation Specialist (CCDS) or Clinical Documentation Improvement Practitioner (CDIP) preferred.
Certified Coding Specialist (CCS) or equivalent coding certification required.
Strong analytical and problem-solving skills.
Proficient in coding software and EHR systems.
Excellent written and verbal communication abilities.
Detail-oriented with a focus on accuracy and compliance.
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member鈥檚 function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
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