CDI QA Reviewer and Educator

Division: Revenue Cycle

Job Title: CDI QA Reviewer & Educator

Job Code:

Position Summary

The CDI QA Reviewer and Educator strengthens clinical documentation quality across the organization through comprehensive audits, targeted education, and expert guidance. This role conducts detailed reviews of medical record documentation and CDI workups, ensuring compliance with ICD‑10‑CM/PCS, DRG methodology, and regulatory standards while supporting accurate and defensible documentation practices.

The position enhances physician documentation quality, promotes accurate DRG assignment, and improves clinical clarity by delivering focused education to CDI specialists and providers. As a subject matter expert, the CDI QA Reviewer and Educator advances documentation improvement efforts, supports coding integrity, and drives continuous organizational improvement.

Statement of Accountability 

Reports to: HIM Director 

Qualifications

· Education

· Licensure

· Work Experience

· Skills/computer/ specific technical

§ Other qualifications, miscellaneous

Specify if qualifications are Required or Preferred

1. Education

· Required: Bachelor’s degree in Nursing or related healthcare field or equivalent experience.

· Preferred: Master’s degree in Nursing, Education, or Healthcare Management or equivalent experience.

2. Licensure/Certification

· Required Credentials: 

o CCDS, CDIP, or CCS or equivalent credential.

· Preferred: RN license and/or AHIMA‑approved ICD‑10 trainer credential. 

3. Work Experience

· Required:

o Minimum of 8 years of CDI and coding/DRG assignment experience in acute care hospitals.

o Minimum of 3 years of experience performing internal CDI and coding reviews and providing clinical education.

· Preferred: 

o Minimum of 10 years of CDI and coding/DRG assignment experience in acute care hospitals.

o Minimum of 5 years of experience performing internal CDI and coding reviews and providing clinical education.

o Prior CDI auditing or supervisory experience.

4. Skills and technical competencies

• Extensive inpatient acute care CDI, coding and DRG assignment experience.

· Strong knowledge of CDI reviews, ICD 10 CM/PCS, DRG methodology, and documentation/coding guidelines.

• Experience in CDI and coding quality reviews, DRG validation, and CDIS and Physician Clinician education.
• Effective communication skills and ability to collaborate with CDIS, Coders, Physicians, and revenue cycle teams.

· Excellent communication, analytical, and education skills.

5. Work Environment

• This is a remote position. On‑site presence may be required for meetings, training sessions, and other operational needs.
• Fast‑paced environment requiring accuracy, initiative, collaboration, and strong follow‑through.
• Ability to work independently in a remote setting with minimal supervision. 

Essential Job Responsibilities

Key Responsibilities

Audit & Quality Review

• Perform routine and ad hoc audits of CDI reviews, provider documentation, and query practices to assess accuracy, completeness, and compliance with internal standards and national guidelines.
• Validate ICD‑10‑CM/PCS, DRG assignment, and coding alignment with clinical evidence and UHDDS/CMS requirements.
• Identify documentation trends, variances, and opportunities for improvement across CDI teams and clinical departments.
• Maintain audit tools, track performance metrics, and present findings to CDI and HIM leadership.
• Support retrospective audits requested by hospital leadership or system‑wide initiatives.

Education & Training

• Develop and deliver CDI education programs, including onboarding, continuing education, and skills refreshers for CDI specialists.
• Provide targeted provider education on documentation best practices, query response expectations, and regulatory changes.
• Create educational materials, tutorials, tip sheets, and presentations; may prepare CEU‑eligible content.
• Offer one‑on‑one coaching based on audit findings or performance trends.
• Participate in CDI program development, education committees, and system‑wide documentation improvement initiatives.

Collaboration & Compliance

• Partner with coding, HIM, compliance, and CDI leadership to ensure alignment of documentation, coding, and query standards.
• Act as a liaison between CDI, physicians, clinical quality, and patient financial services to support documentation accuracy and revenue integrity.
• Support implementation of new documentation guidelines, EHR tools, and CDI workflows.
• Ensure compliance with federal and state regulatory requirements and organizational policies.