This role reviews inpatient medical records and claims to validate coding accuracy, clinical validity, DRG assignment, and compliance, with a focus on documentation improvement and appropriate reimbursement. The consultant develops compliant physician queries, prepares evidence-based audit rationales, and collaborates with physicians and internal clinical experts before findings are shared with clients. The position is fully remote and centers on concurrent use of clinical judgment, coding knowledge, and documentation review tools.
Key Responsibilities
- Audit inpatient records to validate diagnosis and procedure coding, DRG assignment, discharge status, and compliance with facility workflows.
- Review documentation, medications, labs, and orders to identify gaps and support compliant physician queries.
- Coordinate with Enjoin physicians to review DRG recommendations and query opportunities before client submission.
- Write audit rationales using ICD-10-CM/PCS guidelines, AHA Coding Clinic guidance, and query compliance standards.
- Use client reports, workflow systems, encoder tools, and electronic health records to complete reviews and document findings.
- Meet engagement deadlines, maintain workpapers, and support quality and productivity expectations.
- Stay current on coding updates, reimbursement trends, and client-specific requirements.
- Contribute ideas to improve audit quality, workflows, and productivity.
Required
- Bachelor’s degree in Health Information Management or a Registered Nurse credential; other health-related education may be considered case by case.
- CCDS, CDIP, or CCS certification, plus an RN license or RHIA credential.
- At least 5 years of direct CDI specialist experience or experience building a CDI program in an acute care or ambulatory setting.
- At least 5 years of healthcare management experience or 2 years of CDI consulting experience.
- Strong knowledge of ICD-10-CM/PCS coding, MS-DRG reimbursement, and CDI/HIM workflows.
- Experience with EHR systems such as Epic, Cerner, or Meditech and Microsoft Office, including Excel.
Preferred
- 3 or more years of supervisory or management experience.
- 10 years of related healthcare experience, with 3 years of supervisory or management experience considered in lieu of the stated education requirements.
Benefits & Perks
- Fully remote work environment with company-provided equipment.
- Medical, dental, and vision insurance.
- 401(k) with company match.
- Generous paid time off plus eight paid holidays.
- Professional development, leadership training, and internal growth opportunities.
- Recognition programs and performance-based rewards.
- Employee wellness resources and discount programs.
- White glove onboarding support.