Boston Medical Center (BMC) · 1 month ago
CDI Validation Specialist
Boston, MA
Full-time
Onsite
Mid, Senior Level
$83K/yr - $120K/yr
5+ years expBoston Medical Center (BMC) is seeking a CDI Validation Specialist to assist the CDI Manager with the oversight and analysis of Clinical Documentation Improvement (CDI) functions. The role focuses on ensuring the accuracy and efficiency of physician documentation and involves collaborating with various managers to develop training materials and improve documentation outcomes.
Health CareHospitalMedicalNon Profit
Responsibilities
Monitors CDI staff accuracy, data quality and integrity
Monitors CDS review process for content, timeliness and accurate diagnosis and procedure assignment in determining a working DRG
Monitors concurrent queries for compliancy, accuracy, clarity, and timeliness
Audits clinical documentation specialists retrospectively to assess for completes of chart review and query compliance including missed query opportunities, accurate coding, and adherence to AHIMA/ACDIS compliant query guidelines/standards
Collaborates with CDI manager to identify, coordinate, and implement CDI specialist ongoing education and feedback based on identified opportunities for improvement via auditing
Assists in orientation and training of new clinical documentation specialists
Reviews and analyzes denial claims and denial data to provide support in denial prevention strategies via clinical validation query process and education to CDI specialists
Contributes to departmental and organizational quality performance goals, including auditing mortality and readmission cohorts to identify opportunities for improvement. Coordinate and implement CDI specialist education based on identified opportunities
Collaborates with CDI manager to create and update documentation tools, processes, procedures, and work flows on an ongoing and as needed basis
Reviews charts concurrently with no MCC/CCs, low SOI/ROMs and LOS not supported by working DRG
Identifies and educates CDI with missed query opportunities
Assists CDI manager with final DRG validation when there is a discrepancy between CDS and coder
Collaborates with the CDI Manager and identifies opportunities for performance improvement activities on processes
Collaborates with CDI Manager, IP Coding Manager, and IP Coding Validation Manager to strategize appropriate training methodology for individual issues
Provides timely appropriate feedback to CDI Manager on any performance improvement plans for CDI staff
Collaborates with other CDCI department managers to identify areas for improvement and solutions for process improvement
Assures documentation is compliant with federal and state regulations, coding guidelines and hospital policies
Remains up-to-date in clinical and coding/documentation-related materials, including CDS best practices as defined by ACDIS as well as ICD-10-CM/PCS, AHA Coding Clinic guidelines for coding and reporting and MS-DRG/APR-DRG classification systems
Monitors regulatory and reimbursement changes
Serves as resource for CDI informational needs and updates CDI on coding changes, medical science and CDI practice standards
Provides guidance, support and expertise to the CDI specialists
Track trends in documentation concerns and implementing solutions for improvement
Uses leadership and critical thinking skills to identify opportunities for team processes and engagement
Recommend solutions for improvement when deficiencies are identified
Provides CDI specialists, coders, and coding validation specialists with clinical feedback to assist in accurately capture diagnoses and/or opportunities for querying physicians post discharge for additional information
Evaluates the success of concurrent documentation improvement on an ongoing basis
Advances professional growth and development through participation in educational programs and workshops and maintaining knowledge of industry standards and practices
Assists manager, when requested, in the development of APR/DRG/query response physician reports. Maintains complete confidentiality of patient information in addition to hospital and individual physician practice pattern data
Assumes operational oversight of CDI department in the absence of the CDI manager
Adheres to all BMC’s RESPECT behavioral standards
Other duties as assigned
Qualification
Required
Bachelor's degree (or equivalent) in nursing, health information management or related field and at least five years (5) years experience in clinical documentation, or equivalent combination of education and experience, required
Licensed RN
Demonstrate advanced knowledge of clinical documentation integrity practices, policies, workflows, and analysis
Critical thinking, analytical and problem solving skills
Highly organized with strong project/task management skills
Knowledge of federal, state and payer specific regulations, policies and guidelines pertaining to coding (inpatient or outpatient), documentation requirements and billing
Knowledge of care delivery documentation systems and related medical record documents
Knowledge of age-specific needs and the elements of disease processes and related procedures
Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes
Excellent written and verbal communication skills
Excellent critical thinking skills
Demonstrated employee and medical staff relationships in the past and has the ability to maintain those going forward
Working knowledge of inpatient admission criteria
Ability to work independently in a time-oriented environment
Computer literacy and familiarity with the operation of basic office equipment
Assertive personality traits to facilitate ongoing physician communication
Ability to be adapt to changes in the workload, to work independently and effectively prioritize work assignments
Ability to analyze large amounts of data to identify trends
Ability to provide direction and development to employees by coaching, identifying training needs, assigning progressively challenging projects, and assisting in career development planning
Preferred
Master's degree
CCDS, CDIP
Experience with 3M Encoder/Grouper, SMART software preferred
Working knowledge of Medicare reimbursement system and coding structures preferred, but not required
Familiarity with physician practices, health information, case management or related healthcare discipline
Familiarity with all government health care reimbursement systems
Benefits
Medical, dental, vision, pharmacy
Discretionary annual bonuses
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family well-being
Company
Boston Medical Center (BMC)
Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System.
5001-10000 employees
H1B Sponsorship
Boston Medical Center (BMC) has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (53)
2024 (51)
2023 (51)
2022 (38)
2021 (26)
2020 (32)
Funding
Current Stage
Late StageTotal Funding
$342.49MKey Investors
AmeriCorps Public AlliesNational Institute on Drug Abuse (NIDA)The Boston Foundation
2024-07-09Grant· $0.06M
2023-02-23Debt Financing· $232M
2019-04-23Grant· $89M
Leadership Team
David Beck
Senior Vice President & Chief Legal Counsel
Recent News
2025-11-11
2025-11-10
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