CDI Reconciliation Auditor

The CDI Reconciliation Auditor is responsible for performing detailed quality reviews and reconciliations of clinical documentation and coding outcomes, with a focus on DRG (Diagnosis-Related Group) validation and Physician Audit reviews.

Requirements

• Conduct reconciliations of CDI and coding outcomes to ensure alignment with final DRG assignments.
• Review discrepancies between CDI specialists and coders, resolving variances to support accurate claim submission.
• Perform quality audits on Physician Audit reviews to validate the appropriateness of coding and documentation.
• Maintain up-to-date knowledge of coding guidelines (ICD-10, CPT, etc.), payer policies, and regulatory requirements.