Lead CDI Specialist

Job Summary The Lead Clinical Documentation Department Improvement Specialist is a certified coder with advanced clinical proficiency who leads the Clinical Documentation team of licensed nurses and certified coders. The role oversees review of complex pediatric patient records, ensures alignment with payer initiatives, and drives program performance improvement. Responsibilities Serve as subject‑matter expert for the CDI program, inpatient coding, and reimbursement methodologies. Educate medical and hospital staff on MS‑DRG and APR‑DRG reimbursement methodologies. Assist HIM management with coordination of CDI compliance reviews and communication with clinicians. Develop and maintain hospital‑specific CDI, reporting and billing guidelines. Attend hospital committee meetings as needed. Monitor and evaluate case‑mix patterns and trends. Review and code inpatient medical records for backlog and reporting support. Assist with special projects as assigned by HIM management. Maintain current knowledge of reimbursement systems, federal, state and payer‑specific regulations and policies. Complete initial reviews timely to identify potential documentation improvement opportunities. Conduct follow‑up reviews, query physicians for missing or unclear documentation. Educate physicians and key healthcare providers regarding clinical documentation improvement. Collaborate with CDI physician champions, case managers, nursing staff, and ancillary staff to resolve queries prior to discharge. Analyze and trend statistical data for specified patient populations to identify documentation improvement opportunities. Assist in preparation and presentation of clinical documentation monitoring/trending reports. Partner with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation. Assist in the appeal process resulting from third‑party reviews. Proficiency in Microsoft applications, Epic, 3M CRS and 3M CDI 360 Encompass. Qualifications RHIA, RHIT, or CCS certification preferred or eligible (to be achieved within 2 years). CDIP or CCDS certification preferred or eligible (to be achieved within 3 years). Certified coder with strong clinical knowledge of anatomy, physiology, pathophysiology, and pharmacology. In‑depth knowledge of official medical coding guidelines, CMS, and private payer regulations related to the Inpatient Prospective Payment System. Ability to analyze and interpret medical record documentation and formulate appropriate physician queries. Experience with APR‑DRG assignment and documentation impact on severity of illness, risk of mortality. Strong communication and education skills for physicians, nurses, and allied health professionals. Leadership experience in day‑to‑day CDI team processes, workflow and training. Continuing education in CDI, inpatient coding, and reporting compliance areas. Bachelor’s degree in Health Information Management or related field preferred. Benefits Driscoll Children’s Hospital is a 191‑bed tertiary care center that offers a supportive, community‑based environment. The organization values compassion, advocacy, respect, excellence, and stewardship. #J-18808-Ljbffr