Lead CDI Specialist
Core
Lead a Clinical Documentation team of licensed nurses and certified coders to review complex pediatric inpatient medical records, formulate physician queries, and ensure accurate ICD-10 coding and APR-DRG assignments.
Role type
Lead Clinical Documentation Improvement Specialist
Builds
Accurate clinical documentation, coding, and reimbursement data for inpatient medical records
Domain
Healthcare / Medical Coding
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Clinical proficiency in anatomy, physiology, pathophysiology, and pharmacology; Knowledge of CMS and private payer regulations; Ability to analyze medical records and formulate physician queries; Leadership in workflow and training; Data analysis and trending
Preferred skills
RHIA, RHIT, CCS, CDIP, or CCDS certification
Technologies
Epic, 3M CRS, 3M CDI 360 Encompass, Microsoft Word, Excel, PowerPoint
Responsibilities
Oversee review processes of complex pediatric patients; Serve as subject matter expert for CDI program and reimbursement methodologies; Educate medical and hospital staff on documentation practices; Query physicians regarding missing or unclear documentation; Monitor and evaluate case mix patterns and trends; Collaborate with interdisciplinary teams including physicians and case managers; Assist in the appeal process for third-party reviews
Seniority
Senior, hands-on IC with leadership responsibilities