Job Description

CDI specialist on site in Pasadena, CA!

Performs clinical documentation validation.

ESSENTIAL JOB FUNCTIONS:

1. Applies working knowledge of ICD-10 CM & PCS, MS-DRG reimbursement methodology, and Standard of Care in daily medical records reviews.
2. Conducts daily coding reviews of inpatient and outpatient medical records to ensure appropriate billing practices.
3. Analyzes and interprets clinical documentation of diagnoses reported by providers.
4. Formulates accurate clinical review outcomes for reimbursement purpose.
5. Act as a contact person to answer medical review questions submitted by staff or providers.
6. Maintains up to date with regulatory changes related to documentation and coding.
7. Maintains regular and consistent attendance.
8. Adheres to Compliance Plan and HIPAA regulations.
9. Perform coding verification, DRG and clinical validation in accordance with medical standards and CMS guidelines and regulations.

EXPERIENCE:

• Medical Background (MA, LVN, RN, PA, NP, DNP, MD, CDI Specialist, etc.) (Required).
• One (1) year of experience as a concurrent or retrospective documentation specialist in an inpatient acute care facility using the United States Inpatient Prospective Payment System (IPPS). (Desired).
• Min 1 year experience performing medical review for private, federal or state contracts (Desired).

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