Clinical Documentation Integrity (CDI) Specialist

To qualify you must work regularly in a professional inpatient CDI or coding role — hospital CDI (specialist or leadership), inpatient DRG coding/auditing, or clinical-documentation denial management — with 2+ years of experience under ICD-10-CM/PCS and the MS-DRG system.

Clinical documentation knowledge we require

Coding & the pre-bill cycle

• ICD-10-CM/PCS assignment, POA reporting, and the inpatient DRG assignment and reimbursement cycle

• Concurrent and retrospective (pre-bill) review, DRG reconciliation (working vs. final), and tie-out of coded diagnoses to source documentation in the record

Judgment & evaluation

• CC/MCC impact and DRG movement; when a diagnosis does or doesn't change the DRG, severity of illness, or risk of mortality

• Code changes and their coupled effects (principal-diagnosis sequencing, DRG shift, dollar and quality impact)

Clinical standards & criteria

• Applying published clinical criteria to the record — AKI staging (KDIGO), sepsis, respiratory failure, malnutrition, CKD staging — and UHDDS reporting rules

• Distinguishing a clinically supported diagnosis from an unsupported or templated/copy-forward one; clinical validation

Query & compliance discipline

• AHIMA/ACDIS-compliant, non-leading query construction; when a query is required versus when specificity is already provider-documented

• The bright line: indicators justify a query, never a code — never add, delete, or change a provider-documented diagnosis without a provider response

Documentation & evidence

• Query vs. CDI-review vs. note standards, hold/pending mechanics, review-ready completeness

• Evidence provenance: a lab value, document, baseline, or DRG figure is only valid if it is actually in the record and produced by the grouper, not asserted

Tools

• Comfort in professional CAC/CDI software — computer-assisted coding and CDI workflow platforms (e.g., Dolbey Fusion, 3M 360 Encompass, Nuance/Optum360), DRG groupers, and EHR systems (e.g., Epic)

What you'll do

• Review AI-agent attempts at realistic CDI/coding tasks and judge whether each disposition is correct and adequately supported by the record

• Confirm work is actually completed and recorded — codes changed, queries sent (not left in draft), holds placed, DRG recomputed, notes and CDI reviews filed — not just described

• Catch fabricated or overstated work: cited labs, documents, or prior encounters that don't exist, a claimed provider response that never came, DRG or dollar figures not produced by the grouper

• Judge completeness and whether the right action was applied to the right chart — code fix vs. query vs. clinical-validation query vs. leave-alone — and require verify-before-finalize

• Write clear, specific agree/disagree rationales on each attempt

Requirements

• 2+ years of professional experience in one or more of: inpatient hospital CDI (specialist or leadership), inpatient DRG coding/auditing, or clinical-documentation denial management

• Current or recent hands-on work under ICD-10-CM/PCS and MS-DRGs

• Reflexive professional judgment; can spot an unsupported diagnosis, a leading query, a missed CC/MCC, or a rubber-stamped account on sight

• CCDS, CDIP, CCS, RHIA/RHIT, or RN with CDI experience (or equivalent); hospital, coding, or HIM background

• Comfort working inside CAC/CDI software and reading the full clinical record — H&Ps, consults, progress notes, discharge summaries, labs, and flowsheets