Mass General Brigham (Enterprise Services)
CDI Technical Advisor
Mass General Brigham (Enterprise Services), Somerville, Massachusetts, us, 02145
General Overview
The CDI Technical Advisor reports to the Director, CDI Operations and conducts advanced clinical documentation reviews for inpatient encounters to ensure accuracy and compliance with MGB standards and regulatory requirements. This position provides quality assurance for primary CDI reviews, supports accurate code assignment and DRG validation, and ensures optimal reimbursement and data quality for CMS and commercial payors.
Principal Duties and Responsibilities
Identify discrepancies or missed opportunities in clinical documentation that impact severity of illness, risk of mortality, DRG assignment and reimbursement through second level CDI reviews
Escalate complex cases to the CDI leadership team or physician advisors, as needed
Demonstrate service‑line expertise for targeted DRG assignment validation
Facilitate communication between vendor supported primary CDI staff and Coding
Perform pre and post bill audits to ensure accurate reflection of the patient's clinical picture and acuity, specifically concentrating on CMS and commercial payor impact
Provide oversight and quality assurance for the CDI and Coder reconciliation process
Manage and track retro‑query coding requests to CDI
Support provider query escalation process
Identify, monitor and communicate trends and/or gaps in clinical documentation and/or CDI practices
Maintain up‑to‑date knowledge of inpatient coding guidelines, CDI practices, CMS/OIG regulatory changes, and AHA Coding Clinic
Meet or exceed MGB CDI Technical Advisor key performance indicators
Use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
Other duties as assigned
Qualifications
Registered Nurse (RN), Advanced Practice Clinician (NP/PA), or other clinically licensed professional required
5-7 years of acute medical/surgical care experience required
3-5 years of clinical documentation improvement experience required
Certification in Clinical Documentation preferred
Knowledge, Skills and Abilities
Knowledgeable about current CDI industry trends
Deep knowledge of clinical disease processes and inpatient care delivery
Proactive in researching and resolving clinical and CDI questions
Skilled at drafting clear, credible, and compliant clinical queries
Proficient in CDI software to document, track, report outcomes, and collaborate with coding professionals
Advanced understanding of MS‑DRG/APR‑DRG logic, SOI/ROM methodology, and CC/MCC assignment
Recognizes principal diagnosis sequencing opportunities and applies Official Coding Guidelines consistently
Strong analytical, critical thinking, and clinical reasoning skills
Strong attention to detail with commitment to accuracy and compliance
Excellent written and verbal communication skills
Self‑driven, able to prioritize tasks, and adapt quickly to change
Dedicated to continuous learning and professional growth
Team‑oriented with strong collaboration skills
Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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Principal Duties and Responsibilities
Identify discrepancies or missed opportunities in clinical documentation that impact severity of illness, risk of mortality, DRG assignment and reimbursement through second level CDI reviews
Escalate complex cases to the CDI leadership team or physician advisors, as needed
Demonstrate service‑line expertise for targeted DRG assignment validation
Facilitate communication between vendor supported primary CDI staff and Coding
Perform pre and post bill audits to ensure accurate reflection of the patient's clinical picture and acuity, specifically concentrating on CMS and commercial payor impact
Provide oversight and quality assurance for the CDI and Coder reconciliation process
Manage and track retro‑query coding requests to CDI
Support provider query escalation process
Identify, monitor and communicate trends and/or gaps in clinical documentation and/or CDI practices
Maintain up‑to‑date knowledge of inpatient coding guidelines, CDI practices, CMS/OIG regulatory changes, and AHA Coding Clinic
Meet or exceed MGB CDI Technical Advisor key performance indicators
Use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
Other duties as assigned
Qualifications
Registered Nurse (RN), Advanced Practice Clinician (NP/PA), or other clinically licensed professional required
5-7 years of acute medical/surgical care experience required
3-5 years of clinical documentation improvement experience required
Certification in Clinical Documentation preferred
Knowledge, Skills and Abilities
Knowledgeable about current CDI industry trends
Deep knowledge of clinical disease processes and inpatient care delivery
Proactive in researching and resolving clinical and CDI questions
Skilled at drafting clear, credible, and compliant clinical queries
Proficient in CDI software to document, track, report outcomes, and collaborate with coding professionals
Advanced understanding of MS‑DRG/APR‑DRG logic, SOI/ROM methodology, and CC/MCC assignment
Recognizes principal diagnosis sequencing opportunities and applies Official Coding Guidelines consistently
Strong analytical, critical thinking, and clinical reasoning skills
Strong attention to detail with commitment to accuracy and compliance
Excellent written and verbal communication skills
Self‑driven, able to prioritize tasks, and adapt quickly to change
Dedicated to continuous learning and professional growth
Team‑oriented with strong collaboration skills
Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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