Intermountain Health · Peaks Regional OfficePrepare for this interview
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Job Description: The Physician Advisor Services - CDI Specialist is responsible for improving the accuracy, completeness, and integrity of clinical documentation to ensure the medical record accurately reflects the patient's clinical status, supports optimal patient care, and fulfills regulatory, quality, and reimbursement requirements. Through concurrent and retrospective review, this role applies advanced clinical judgment and knowledge of documentation standards to identify clinical indicators, clarify diagnoses with providers, and ensure proper capture of severity of illness, risk of mortality, and risk adjustment variables. The CDI Specialist partners closely with Clinical Documentation Integrity (CDI), Coding, Physician Advisors, Care Management, Quality, and regulatory teams to strengthen documentation performance across assigned facilities. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings. We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, Vermont, Washington. Concurrent & Retrospective CDI Reviews - Performs comprehensive reviews of inpatient medical records to ensure documentation accurately reflects the patient's clinical presentation, diagnoses, treatments, and outcomes. - Identifies opportunities to improve capture of SOI, ROM, HCC, CC/MCC, DRG accuracy, and risk adjustment elements. - Ensures clinical documentation supports the acuity represented in coding and reimbursement methodologies. Provider Engagement & Clinical Clarifications - Collaborates with physicians and advanced practice providers to clarify ambiguous, incomplete, or conflicting documentation. - Provides education on documentation best practices, clinical criteria, and regulatory expectations. - Utilizes compliant query practices according to industry standards. Clinical Validation & Evidence-Based Criteria Application - Applies Intermountain clinical program criteria, service line guidance, and national evidence-based clinical indicators to validate diagnoses. - Identifies documentation that does not meet clinical validation standards and engages providers appropriately. - Supports documentation requirements for quality programs, infection prevention, patient safety, and publicly reported measures. Collaboration With Coding, Physician Advisors, & Care Management - Works closely with coding professionals to ensure accurate DRG assignment and alignment of documentation with coded data. - Partners with Physician Advisors to review complex clinical scenarios, documentation gaps, and medical necessity considerations. - Collaborates with Care Management to supply patient data needed for Utilization Review, Conditions of Participation, and status determinations. Quality, Risk Adjustment, & Regulatory Requirements - Evaluates documentation for impacts on mortality metrics, PSI/HAC, infection prevention, VBP, CMS Star Ratings, and other publicly reported outcomes. - Ensures documentation supports both commercial and government payer requirements. - Understands national HCC, RAF, DRG, and prospective payment methodologies. Denials Prevention & Appeals Support - Identifies documentation gaps that may result in medical necessity or DRG-related denials. - Works with the Appeals Unit and Physician Advisors to support clinical appeal efforts and prevent payment denials. Data, Analytics & Reporting - Maintains CDI metrics including accuracy rates, clarification trends, compliance issues, and documentation outcomes. - Contributes to dashboards and analytics that inform CDI and PAS program priorities. - Supports data abstraction requirements for internal and external reporting.
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