Clinical Documentation Integrity Specialist 2

Inova Health is looking for a dedicated Clinical Doc Integrity Spec 2 to join the team. This role will be Full-time Day Shift: Monday – Friday working remotely.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. 

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.

• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

Clinical Doc Integrity Spec 2 Job Responsibilities:

• Performs initial case reviews and an appropriate number of follow-up reviews based on program standards. Uses clinical insight and judgment of clinical findings to assess clinical documentation for improvement opportunities. Independently develops complex queries. Follows up with the physician responsible for the care of the patient, via the query process, for clarification of clinical significance and appropriate documentation.
• Maintains query rate, response rate, and agreement rate in line with established performance benchmarks.
• Assists with reviewing records at different Inova hospitals as needed and under the supervision of assigned CDI leaders.
• Participates in all department-wide CDI and coding education on ICD-10, MS-DRG, and quality outcome measures as well as compliance requirements related to query (AHIMA Practice brief).
• Maintains competency in the use of CDI applications to process daily work lists and report results of record reviews and queries.
• Enters all required data into CDI applications to enable Coding professionals and Coding Quality Coordinators to determine the disposition of concurrent queries in order to assign the final MS-DRG as well as APR-DRG, SOI, and ROM and risk adjustment factors. Demonstrates expert knowledge of ICD 10 codes and MS-DRG/APR DRG assignments.
• Interacts with Coding Quality Coordinators and Coding professionals on any questions related to CDI working DRG related to concurrent queries and final coding.
• Assists with any post-discharge (retrospective) queries per CDI policy/procedure and as requested by CDI leadership.
• Demonstrates advanced technical ability with current software used by the department.
• Provides electronic support to providers regarding best practice documentation standards and the query process. Provides 1:1 provider education within the daily workflow and participates in group education sessions as requested by CDI Leadership.
• Participates in special projects, audits, and other duties as directed by CDI Leadership. May assist with precepting and education of new staff.
• Works collaboratively with medical, nursing, and ancillary staff to improve the quality of chart documentation that assures appropriate DRG classification to accurately reflect patient severity of illness and risk of mortality.
• Participates, and takes a leadership role in, select special projects, audits, and other duties as directed by CDI Leadership.
• As needed, may travel across the Washington DC metro area to engage with providers.
• May perform additional duties as assigned. 

Minimum Requirements: 

• Education: Associate Degree (RN, MD, RHIA/RHIT)
• Experience: 
  • Five years of professional inpatient acute care, inpatient clinical, and/or coding experience required. Includes ICU, ER, Peds/NICU, case management/UR, quality or similar level of advanced care/coding.
  • Two years of CDI experience in an acute inpatient healthcare setting.
• Certification: CDI certification (CCDS or CDIP)
• Licensure: RN, RHIT, or foreign medical school licensure documentation equivalent to educational background required.

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare. 

Inova Health System is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.