CORP CDI AUDITOR-EDU

Overview

CDI Auditor & Educator

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

Position Summary:

The CDI Auditor/Educator performs and reviews complex internal coding and clinical documentation audits for inpatient CDI accounts. This role leads or conducts audit projects across Covenant Health entities, focusing on coding, documentation, and billing compliance. The position also provides consulting services, coordinates coding investigations, and is responsible for education and training of CDI staff. The CDI Auditor/Educator serves as a resource to coders, CDI professionals, Quality and Case Managers, and Decision Support teams.

This role upholds all organizational and professional ethical standards and collaborates with Covenant leadership to coach, mentor, and train coding and CDI staff. The position operates independently with minimal supervision and significant latitude for initiative and independent judgment.

Responsibilities

• Identify and evaluate risk areas; develop and implement CDI auditing procedures related to documentation and reimbursement.
• Collaborate with coders and/CDI staff to provide education and feedback; proactively addresses issues with CDI management.
• Monitor CMS and OIG publications to ensure compliance with coding, billing, and reimbursement regulations.
• Reviews third- party payers guidelines to ensure accurate claims charging, coding, and billing.
• Communicate audit results through written reports and presentations to relevant stakeholders.
• Documents audit activities and report findings regularly.
• Serve as a resource for hospital departments regarding coding and documentation.
• Conduct CDI audits with regards to payor denials if/when necessary.
• Collaborate with health information management, Revenue Integrity, patient accounting, and other departments to implement compliance solutions.
• Support the Chief Compliance Officer on coding, billing and reimbursement compliance issues.
• Performs ongoing audits to identify process improvement education opportunities.
• Deliver detailed ICD-10 training to CDI staff.

General

• Maintains professional development through continuing education and industry engagement.
• Recognizes situations requiring supervision and seeking appropriate guidance.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:           

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Minimum Experience:         

Three (3) to five (5) years’ experience in CDI.  Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations. Experience in problem solving, analytical reviews, Must be knowledgeable in use of PC's, Windows, Excel and Word Processing; Must have good public relations, educational skills.

Licensure Requirement:      

Certification in field of study. The following certifications are acceptable RHIT/RHIA, CCS, CCDS, or CDIP.