CDI Auditor

Job-ID: 25630Category: NursingLocation: Sayre, PA, United StatesSchedule: Full timePosted: 2026-10-20Benefits Eligible: YesIs this a Union position?: NoGrade: N27Working Hours: 40Position Summary  Performs advanced clinical documentation reviews to ensure the accuracy, completeness, and integrity of the medical record in support of quality outcomes, reimbursement, and regulatory compliance. Responsible for second-level review of complex cases, including mortality reviews, denial validation, and PSI/HAC review. Identifies documentation gaps, validates clinical accuracy, and trends risk patterns across the organization. Collaborates with CDI leadership and interdisciplinary partners to support a continuous feedback model that promotes documentation improvement and reduces organizational risk. Education, Licensure & Certifications  Bachelor of Science in Nursing (BSN) required; Master’s degree preferred  CCDS certification required    Experience Requirements  Prior CDI experience required with a minimum of 3–5 years in CDI, including advanced review experience. Minimum of 5 years clinical experience in an acute care setting required. Experience with mortality review, denial management, clinical validation, and DRG integrity strongly preferred. Requires strong analytical, critical thinking, and problem-solving skills. Must demonstrate ability to evaluate complex clinical scenarios and identify documentation and coding inconsistencies. Essential Functions  Performs second-level clinical documentation reviews, including retrospective and concurrent evaluation of complex inpatient cases. Conducts comprehensive mortality reviews to validate documentation accuracy, risk adjustment (SOI/ROM), and alignment with coded outcomes. Identifies opportunities impacting observed versus expected (O/E) mortality performance. Reviews payer denials to assess clinical validity, documentation support, and DRG integrity. Identifies root causes and trends to support denial prevention and appeal strategies. Performs focused review of Patient Safety Indicators (PSIs) and Hospital-Acquired Conditions (HACs) to ensure accurate documentation and alignment with reported outcomes. Validates clinical diagnoses and documentation to ensure compliance with coding guidelines, clinical validation standards, and regulatory requirements. Identifies and trends documentation risks, gaps, and opportunities across mortality, denials, PSI/HAC, and high-risk clinical scenarios. Provides structured insights and recommendations to support performance improvement initiatives and program development. Collaborates with CDI, Coding, Quality, and Revenue Cycle teams to resolve discrepancies and improve documentation integrity. Supports the development of appeal rationale and documentation strategies for complex or disputed cases. Maintains current knowledge of coding guidelines, clinical validation expectations, and regulatory requirements. Participates in process improvement initiatives to enhance documentation accuracy, reduce denials, and improve quality outcomes. Other Duties: Participates in departmental and organizational committees and task forces. May travel to other Guthrie entities as needed. Performs other duties as assigned. update 10-5-26About the companyJoining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you’ll find staff members who have committed themselves to serving the community.The Guthrie Clinic is an Equal Opportunity Employer.The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine.