Quality Improvement CDI Specialist

+ DEPARTMENT: 17117 - Clinical Documentation Integrity + LOCATION: 350 7th Street North, Naples, FL, 34102 + WORK TYPE: Full Time + WORK SCHEDULE: Standard Office ABOUT NCH NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care. NCH is transforming into an Advanced Community Healthcare System(TM) and we're proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan. Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit to learn more. JOB SUMMARY The Quality Improvement Clinical Documentation Integrity Specialist (QI-CDIS) responsibilities include comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, act as a liaison between coding and CDI to resolve DRG or other code discrepancies, collaborate with CDI Liaison to educate CDI team based on opportunities identified in second level reviews and work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and/or provider education. The QI-CDIS will collaborate closely with Coders, Coding Educators, Coding Quality Auditors, Case managers, Quality Department and Providers to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards. Will provide other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES - Other duties may be assigned. u2022 Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent/retrospective query process following ACDIS/AHIMA Guidelines for Compliant Query Writing (2022). u2022 Completes comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and/or code discrepancies; low acuity DRGs, medical/surgical DRGs without cc/mcc capture exceeding the expected GMLOS, mortality/discharge to hospice reviews to ensure documentation supports risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnosis as identified for potential missed opportunities to clarify documentation or clinically validate a diagnosis. u2022 Acts as a liaison between the Coding Department and the Clinical Documentation Integrity Specialist to reconcile discrepancies in code and/or DRG assignment u2022 Communicates findings of secondary reviews to respective Clinical Documentation Integrity Specialist for educational opportunities/outcomes. u2022 Collaborates with CDI liaison/quality auditor when educational needs are identified from second level reviews. u2022 Documents and tracks second level reviews and results. Shares this information with staff at regular scheduled CDI team meetings as well as other meetings (i.e. UM/Quality etc). u2022 Collaborative interaction with physicians and/or other clinicians to enhance understanding of the CDI program goals; ensure the medical record can be coded accurately to accurately reflect complexity/acuity of each patient encounter. u2022 Spends most of the work weeks on-site at the hospital as a resource, developing relationships and educating. EDUCATION, EXPERIENCE AND QUALIFICATIONS u2022 Minimum of Associate Degree required; Bachelor's Degree preferred. u2022 Licensed as a Registered Nurse in the state of Florida. u2022 5+ years CDI auditing/SLR or education experience; coding experience; or previous CDI experience in an academic institution; or 3+ years CDI auditing/SLR or education experience; coding experience; or previous CDI experience in an academic institution with 2+ years of leadership experience. u2022 Team leading experience preferred. u2022 Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) Certification required. u2022 Advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an inpatient setting. u2022 Strong understanding of coding application, rules, and guidelines. u2022 Ability to formulate clinically, compliant and credible physician queries as per guidelines set forth in the AHIMA/ACDIS query practice brief. u2022 Working knowledge of federal, state, and private payer regulations as well as applicable organizational policies and procedures. u2022 Experience in MS-DRG and APR-DRGs, risk adjustment, HACs and PSIs, O/E mortality, and LOS. u2022 Working knowledge of quality improvement theory and practice, core measures, safety, and other required reporting programs. u2022 In-depth knowledge of MS-DRG payer issues, documentation opportunities, coding guidelines and changes to include Coding Clinic, and clinical documentation requirements. u2022 Excellent verbal and written communication skills, analytical thinking, and problem solving with strong attention to detail. u2022 Proficiency in organizational skills and planning, with an ability to multitask in a fast-paced environment. u2022 Experience interacting with and educating medical staff and clinical support staff. u2022 Proficiency in computer use, including database and spreadsheet analysis, presentation programs, word processing, and internet research. u2022 Computer experience, especially with electronic medical record (EPIC) computerized encoder products (3M360 Encompass clinical application). u2022 Proficiency in Excel and PowerPoint. u2022 Intermediate computer knowledge: Microsoft Word, Excel, Outlook, and Windows

Created: 2025-12-15