NOR Healthcare Systems·Bellflower, California
The CDI Specialist conducts concurrent and retrospective reviews of inpatient medical records to ensure documentation reflects medical necessity and quality of care. They work closely with medical staff to resolve documentation ambiguities and facilitate accurate coding and reimbursement.
The CDI Specialist Level II is responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate if clinical documentation is reflective of medical necessity, quality of care outcomes and reimbursement compliance for acute care services provided. Works closely with the medical staff to facilitate appropriate clinical documentation of patient care. Other responsibilities include conducting initial and extended-stay concurrent reviews on all selected admissions and documenting findings. Essential Job Functions / Major Areas of Responsibility The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position. Reviews inpatient medical records, meeting all department productivity goals, for identified payor populations as directed on admission and throughout hospitalization and identifies potential gaps in physician documentation. Ensures that clinical documentation reflects the level of service rendered to patients in a complete, accurate and compliant manner. Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process, meeting department productivity goals. Follows up with the physicians to get resolution of all queries prior to patient's discharge to ensure accurate quality data and appropriate reimbursement whilst maintaining up to date DRG. Assists coders in follow-up on queries and clarifications to physicians done retrospectively post patient discharge. Coordinates the daily operations of the department, troubleshooting and resolving issues as they occur. Educates others on documentation guidelines on an ongoing basis. Performs as a role model and consistently demonstrates an advanced level of expertise and enhanced communication skills. Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through comprehensive auditing and evaluation of the medical record. Collects and analyzes data to provide reports and make recommendations. Works collaboratively with Performance Improvement Department to improve clinical documentation for compliance in quality of care measures. Performs the duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and all regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician. Follow-up in improving clinical documentation to reduce such denials. Works collaboratively with health information management coding staff, physicians and financial services to resolve payment denials and documentation issues. Regularly participates in scheduled case management meetings and actively exchanges information pertaining to clinical documentation, plan of care affecting coding and reimbursement. Required Qualifications CDIP or CCDS Medical Graduate, Physician Assistant or Registered Nurse (Current CA License) Minimum 1 year of previous practical floor CDI experience in an acute care setting Ability to multitask and maintain a work pace appropriate to workload Must demonstrate customer service skills appropriate to the job Excellent written and verbal communication skills in English Ability to effectively communicate with physicians in a clear and concise manner Computer literacy and proficiency Hospital Fire and Life Safety Card (Los Angeles City Employees only)
CCS Physical Requirements Indicate physical requirements for performing the essential functions of the job by double clicking and selecting 'checked' on the boxes below. These are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable, state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation. Standing - Frequently Walking - Frequently Sitting - Frequently Reaching with Hands and Arms - Occasionally Climb or Balance - Occasionally Stooping, Kneeling, Crouching, or Crawling - Occasionally Talking - Frequently Hearing - Constantly Seeing - Constantly Performing repetitive motions with arms or hands - Frequently Lifting, carrying, pushing or pulling up to 10 lbs - Constantly Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally Lifting, carrying, pushing or pulling up to 50 lbs - None Lifting, carrying, pushing, or pulling greater than 50 lbs - None Driving - None Pay Rate: Min - $93,800 | Max - $128,950
Candidates must hold a current California license as a Registered Nurse, Physician Assistant, or be a Medical Graduate with at least one year of practical floor CDI experience. Professional certifications such as CDIP or CCDS are required.
Market context
Clinical Documentation Improvement Specialist roles in California are often competitive because hospitals and health systems need clinicians who can translate chart review into accurate coding and compliant documentation. This position stands out for requiring a current California RN or PA license, or a medical graduate with floor CDI experience, plus CDIP or CCDS certification. Review the AI-summarized requirements and benefits on this platform to save time, then confirm your documentation examples and certification status before applying.
