Revenue Cycle Integrity/CDI Specialist

EDUCATION (must be required for position), LICENSE, CERTIFICATION and EXPERIENCE: :
1.

Education High School Diploma, or GED preferred.
2.

Licenses No professional license required.
3.

Certifications RHIA, HIM, RHIT, CCS, CCDS, or CDIP certification (Preferred or Required depending
on organization).
4.

Experience Minimum 3-5 years of experience in CDI, revenue integrity, or related roles within a
healthcare setting required.

REQUIRED SCREENINGS:
• Drug Screen
• Physical Assessment
• Tuberculosis screen
• Background check (Criminal, Civil, Educational, Previous Employment, etc.)
• Driver Record screen (positions requiring on-the-job driving)

ESSENTIAL FUNCTIONS:
GENERAL DUTIES:
• Reliable and punctual attendance is essential; expected to be at job as scheduled each scheduled day.
• Communicate necessary information to others as appropriate.
• Knowledge of HIPAA regulations and healthcare compliance
Revenue Integrity:
• Monitor and audit charge capture and billing processes for accuracy, completeness, and
compliance.
• Collaborate with clinical, billing, and coding teams to identify revenue leakage, charge
lag, and denials trends.
• Evaluate and improve charge master integrity in partnership with the CDM and coding
teams.
• Analyze revenue cycle KPIs, reimbursement trends, and payer policies to ensure optimal
reimbursement.
• Develop and implement education and process improvement plans to support accurate
documentation and billing.
Clinical Documentation Improvement (CDI):
• Conduct concurrent and retrospective reviews of inpatient and/or outpatient medical
records to ensure accurate and complete documentation for coding and quality reporting.
• Query providers to clarify diagnoses, procedures, and clinical indicators to support
accurate DRG/APC assignment and severity of illness (SOI)/risk of mortality (ROM)
scores.
• Serve as a liaison between providers, coders, and clinical departments to ensure accurate
and thorough documentation.
• Provide ongoing CDI education and feedback to clinical staff to promote best
documentation practices.
• Support documentation requirements related to quality programs, audits, and compliance
initiatives.
• Strong knowledge of ICD-10, CPT, EAPG/APC reimbursement methodologies, Method
ll billing, Critical Access Hospital billing requirements and CMS compliance guidelines

GENERAL SKILLS
• Strong attention to detail with a high level of accuracy.
• Strong organizational and time management skills.
• Excellent analytical, communication, and collaboration skills.
• Experience with EHR systems (e.g., Epic, Cerner) and data analytics tools is a plus.
• Knowledge of payer contract language and reimbursement methodologies.
• Understanding of risk adjustment models (e.g., HCC, MS-DRG).
• Ability to interpret clinical documentation and translate it into coding and billing
language.

Wage Starts at $27.00 and goes up with experience

Immunizations required for employment...