CDI QA Reviewer and Educator

The position enhances physician documentation quality, promotes accurate DRG assignment, and improves clinical clarity by delivering focused education to CDI specialists and providers. As a subject matter expert, the CDI QA Reviewer and Educator advances documentation improvement efforts, supports coding integrity, and drives continuous organizational improvement.

·   Education

·   Licensure

·   Work Experience

·   Skills/computer/ specific technical

§ Other qualifications, miscellaneous

Specify if qualifications are Required or Preferred

·         Required: Bachelor’s degree in Nursing or related healthcare field or equivalent experience.

·         Preferred: Master’s degree in Nursing, Education, or Healthcare Management or equivalent experience.

2. Licensure/Certification

·         Required Credentials:

o   CCDS, CDIP, or CCS or equivalent credential.

·         Preferred: RN license and/or AHIMA‑approved ICD‑10 trainer credential.

3. Work Experience

·         Required:

o   Minimum of 8 years of CDI and coding/DRG assignment experience in acute care hospitals.

o   Minimum of 3 years of experience performing internal CDI and coding reviews and providing clinical education.

·         Preferred:

o   Minimum of 10 years of CDI and coding/DRG assignment experience in acute care hospitals.

o   Minimum of 5 years of experience performing internal CDI and coding reviews and providing clinical education.

o   Prior CDI auditing or supervisory experience.

4. Skills and technical competencies

• Extensive inpatient acute care CDI, coding and DRG assignment experience.

·         Strong knowledge of CDI reviews, ICD 10 CM/PCS, DRG methodology, and documentation/coding guidelines.

• Experience in CDI and coding quality reviews, DRG validation, and CDIS and Physician Clinician education.
• Effective communication skills and ability to collaborate with CDIS, Coders, Physicians, and revenue cycle teams.

·         Excellent communication, analytical, and education skills.

5. Work Environment

• This is a remote position. On‑site presence may be required for meetings, training sessions, and other operational needs.
• Fast‑paced environment requiring accuracy, initiative, collaboration, and strong follow‑through.
• Ability to work independently in a remote setting with minimal supervision.

Essential Job Responsibilities

• Perform routine and ad hoc audits of CDI reviews, provider documentation, and query practices to assess accuracy, completeness, and compliance with internal standards and national guidelines.
• Validate ICD‑10‑CM/PCS, DRG assignment, and coding alignment with clinical evidence and UHDDS/CMS requirements.
• Identify documentation trends, variances, and opportunities for improvement across CDI teams and clinical departments.
• Maintain audit tools, track performance metrics, and present findings to CDI and HIM leadership.
• Support retrospective audits requested by hospital leadership or system‑wide initiatives.

Education & Training

• Develop and deliver CDI education programs, including onboarding, continuing education, and skills refreshers for CDI specialists.
• Provide targeted provider education on documentation best practices, query response expectations, and regulatory changes.
• Create educational materials, tutorials, tip sheets, and presentations; may prepare CEU‑eligible content.
• Offer one‑on‑one coaching based on audit findings or performance trends.
• Participate in CDI program development, education committees, and system‑wide documentation improvement initiatives.

Collaboration & Compliance

• Partner with coding, HIM, compliance, and CDI leadership to ensure alignment of documentation, coding, and query standards.
• Act as a liaison between CDI, physicians, clinical quality, and patient financial services to support documentation accuracy and revenue integrity.
• Support implementation of new documentation guidelines, EHR tools, and CDI workflows.
• Ensure compliance with federal and state regulatory requirements and organizational policies.