[Hiring] Second Level Reviewer @Guidehouse

Role Description

Second level reviewer responsibilities include comprehensive, clinical chart reviews to ensure the most accurate reflection of the patient’s care and diagnosis following Official Coding Guidelines, Coding Clinics, and Client policies.

The Clinical Documentation Integrity (CDI) Second Level Reviewer will:

• Collaborate closely with the CDI team, Physician Advisors, Providers, Clinicians, Coding Educator, Coding Quality Auditors, Case Managers, and Quality Department.
• Ensure documentation is clinically appropriate and accurately reflects the severity of illness and risk of mortality for the patient.
• Apply ACDIS best practices for writing clinical documentation integrity clarifications.
• Collaborate with CDI Management/Educator to identify opportunities for education.
• Adapt to various clinical and administrative needs.
• Understand quality risk models and apply them during secondary reviews.
• Demonstrate excellent verbal and written communication skills.
• Act as a liaison between the Coding Department and the Clinical Documentation Specialist.
• Exhibit adeptness in quickly learning and adapting to new technologies.
• Utilize EHR systems, CDI software, and encoders to optimize workflow.
• Apply principles of clinical validation and ensure queries are compliant with AHIMA guidelines.

Duties include:

• Analyzing and interpreting clinical data to identify gaps and opportunities for improvement.
• Collaborating with the Quality Department on annual quality initiatives.
• Completing comprehensive, clinical secondary reviews of targeted patient populations.
• Meeting second level review productivity, quality, and turnaround expectations.
• Documenting and tracking the results of secondary reviews.
• Participating in departmental and hospital committees and task forces.
• Contributing to a positive and collaborative working environment.
• Complying with HIPAA and code of conduct policies.

Qualifications

• Graduation from accredited School of Nursing with BSN, ADN OR Graduation from accredited medical school with MD or equivalent OR bachelor’s or master’s degree in health-related field.
• Currently licensed as a Registered Nurse, MD or MD equivalent OR Credentialed Medical Coder through AHIMA with current CCS, RHIA or RHIT credential and CDIP or CCDS.
• 4-6 years previous relevant experience in clinical documentation, CDI second level review, or inpatient coding quality review.
• Must maintain credentials while employed.

Requirements

• Strong understanding of disease processes, clinical indications, and treatments.
• Provider documentation requirements to reflect severity of illness and risk of mortality.
• Solid understanding of hospital acquired conditions (HAC’s), patient safety indicators (PSI’s), and mortality models.

Benefits

• Medical, Rx, Dental & Vision Insurance.
• Personal and Family Sick Time & Company Paid Holidays.
• Position may be eligible for a discretionary variable incentive bonus.
• Parental Leave.
• 401(k) Retirement Plan.
• Basic Life & Supplemental Life.
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts.
• Short-Term & Long-Term Disability.
• Tuition Reimbursement, Personal Development & Learning Opportunities.
• Skills Development & Certifications.
• Employee Referral Program.
• Corporate Sponsored Events & Community Outreach.
• Emergency Back-Up Childcare Program.