Job Description

Quality Auditor – CDI


locations Remote, USA

time type Full time

posted on Posted 14 Days Ago

job requisition id R230000007666

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1® is a publicly traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

This position is responsible for audit and analysis of Clinical Documentation Integrity (CDI) staff chart reviews and concurrent queries. Works collaboratively with CDI Leadership to ensure appropriate collection, management, and reporting of data to improve accuracy and quality in the clinical documentation of patient records.

Duties and Responsibilities

  • Performs routine audits on charts and concurrent queries written by CDI and coding staff with focus on quality to ensure compliance with query guidelines and necessity of query.
  • Validate the completeness of documentation, identify diagnoses and procedures that are missed, propose physician queries, and ensure the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment.
  • Prepares audit reports for CDI leadership team. Provides real-time performance feedback to staff on appropriateness and accuracy of queries as well as provide education, as needed, to correct any issues found.
  • Develops and delivers clinical documentation improvement education for physicians, coders and CDSs Attends meetings as requested, which may necessitate working in the evening or very early morning.
  • Possesses the ability to develop and present effective education utilizing a variety of media platforms.
  • Collaborates on the development, implementation and maintenance of standardized policies and procedures for data capture, analysis, and retention; reporting of identified areas of risk; and mitigation of issues.
  • Maintains proficiency in AHA Coding Clinic official coding guidelines for coding and reporting. Possesses an excellent understanding of coding practices, official coding guidelines and federal regulations.
  • Maintains auditing skills for coding quality, MS-DRG and APR-DRG assignments, PSIs, HCCs, and documentation and documentation.
  • Responsible for large scale, multi-facility, high risk projects across multiple departments system-wide and requires interaction at all levels of staff and management.
  • Requires work in context of multiple commitments, priorities, and conflicts.
  • Trains and mentor new facility CDSs. Assists with other special projects as assigned by CDI leadership team.

Required Qualifications:

  • Bachelor’s degree in a work-related discipline/field (such as Nursing, Human Information Management) or enrolled in a bachelor’s program.
  • RN License, RHIA or RHIT
  • A minimum of three years’ experience in clinical documentation improvement, ICD10 CM/PCS, APR-DRGs and MS-DRGs
  • Three years’ experience providing physician, CDS and coder education in an acute care setting.
  • Knowledge on the use of 3M 360 Encompass and Nuance CDE One.
  • 10% Travel required.

Preferred Qualifications:

  • Minimum of one year auditing experience