Clinical Documentation Integrity - Second Level Reviewer

Position Overview

The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex, secondary case reviews to facilitate and obtain appropriate provider documentation for clinical conditions or procedures that reflect severity of illness, expected risk of mortality, accuracy of patient outcomes, and complexity of patient care. This role serves as a key resource for Responsibilities: CDI, Coding, and Quality by collaborating with CDI & quality leadership, specialists, coders, quality analysts, providers, and other healthcare team members. The reviewer adheres to departmental and organizational goals, standards, policies, and procedures to ensure quality documentation and regulatory compliance.

Key Responsibilities

• Ensures accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes.
• Performs high-level, complex, timely secondary case reviews both concurrently and retrospectively to identify gaps or opportunities for improved provider documentation.
• Ensures that clinical documentation accurately reflects the level of care rendered, severity of illness, risk of mortality, and clinical validation in compliance with government and other regulations.
• Applies advanced knowledge of CMS star rating, Vizient, and US News & World Report risk-adjustment systems to identify clinical documentation improvement opportunities.
• Completes quality reviews focused on CDI quality elements, including Mortality, Hospital Acquired Conditions (HAC), and other publicly reported patient safety or quality metrics.
• Identifies trends and key areas for improvement in querying, coding, and documentation integrity.
• Demonstrates proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG by providing insights regarding documentation improvement opportunities, coding and DRG issues, and performance improvement methodologies.
• Recognizes opportunities for documentation improvement using critical-thinking skills, sound judgment, and a focus on compliance, outcomes, reimbursement, and regulatory requirements.
• Facilitates high-quality documentation by formulating queries that are clear, concise, effective, and compliant with the latest AHIMA/ACDIS guidelines.
• Recommends potential refinements to principal and secondary diagnoses and/or procedures based on clinical data to support appropriate DRG assignment.
• Accurately records review findings and relevant data into CDI software and other data systems to support data integrity for reporting.
• Communicates and collaborates effectively with providers, HIM/coding, quality, CDI, and other healthcare team members.
• Assists with concurrent and retrospective CDI case reviews, quality audits, and educational initiatives as required by CDI leadership.
• Works independently while demonstrating effective time management and prioritization of tasks.
• Participates actively in meetings, provides feedback, identifies trends, and supports educational presentations as needed.
• Takes responsibility for professional development through workshops, conferences, and in-service training, maintaining appropriate records of participation.
• Participates in departmental and organizational projects, task forces, or committees as assigned.
• Ensures compliance with HIPAA and the Code of Conduct policies.

Required Qualifications

• Education: Four (4) Year/bachelor’s degree required; BSN/BS/BA in a related field required.
• Experience Required: At least three (3) years of recent inpatient clinical documentation improvement (CDI) experience; proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG; and at least one (1) year of experience with mortality, PSI, HAC, or other quality-focused reviews.
• Requirements: Current RN or MD required; CCDS or CDIP certification is required.
• Excellent written and verbal communication skills with the ability to write concisely and effectively when communicating with providers.
• Demonstrated extensive clinical knowledge, critical-thinking skills, and a solid understanding of disease processes, pathophysiology, and disease management.
• Proficiency with CDI software and encoder applications.

Preferred Qualifications

• Graduate degree in Healthcare Administration, Informatics, Nursing, Leadership, Education, or a related field.
• Coding certification (CCS, CIC, or CPC) is preferred.
• At least three (3) years of direct patient care clinical experience in a hospital setting.
• Knowledge of Vizient, Premier, US News & World Report, CMS star rating, or similar risk-adjustment methodologies.
• Prior experience in an academic medical center (AMC) or a large health system.
• Experience with 3M 360 Encompass is a plus.

Benefits & Perks

• Benefits: Competitive salary and a comprehensive benefits package including medical, dental, and tuition remission.
• Location: University of Miami.
• Schedule: Full time, Staff position.