Revenue Cycle Integrity/Cdi Specialist

EDUCATION (must be required for position), LICENSE, CERTIFICATION and EXPERIENCE: :

1. Education High School Diploma, or GED preferred.

2. Licenses No professional license required.

3. Certifications RHIA, HIM, RHIT, CCS, CCDS, or CDIP certification (Preferred or Required depending

on organization).

4. Experience Minimum 3-5 years of experience in CDI, revenue integrity, or related roles within a

healthcare setting required.

REQUIRED SCREENINGS:

• Drug Screen
• Physical Assessment
• Tuberculosis screen
• Background check (Criminal, Civil, Educational, Previous Employment, etc.)
• Driver Record screen (positions requiring on-the-job driving)

ESSENTIAL FUNCTIONS:

GENERAL DUTIES:

• Reliable and punctual attendance is essential; expected to be at job as scheduled each scheduled day.
• Communicate necessary information to others as appropriate.
• Knowledge of HIPAA regulations and healthcare compliance

Revenue Integrity:

• Monitor and audit charge capture and billing processes for accuracy, completeness, and

compliance.

• Collaborate with clinical, billing, and coding teams to identify revenue leakage, charge

lag, and denials trends.

• Evaluate and improve charge master integrity in partnership with the CDM and coding

teams.

• Analyze revenue cycle KPIs, reimbursement trends, and payer policies to ensure optimal

reimbursement.

• Develop and implement education and process improvement plans to support accurate

documentation and billing.

Clinical Documentation Improvement (CDI):

• Conduct concurrent and retrospective reviews of inpatient and/or outpatient medical

records to ensure accurate and complete documentation for coding and quality reporting.

• Query providers to clarify diagnoses, procedures, and clinical indicators to support

accurate DRG/APC assignment and severity of illness (SOI)/risk of mortality (ROM)

scores.

• Serve as a liaison between providers, coders, and clinical departments to ensure accurate

and thorough documentation.

• Provide ongoing CDI education and feedback to clinical staff to promote best

documentation practices.

• Support documentation requirements related to quality programs, audits, and compliance

initiatives.

• Strong knowledge of ICD-10, CPT, EAPG/APC reimbursement methodologies, Method

ll billing, Critical Access Hospital billing requirements and CMS compliance guidelines

GENERAL SKILLS

• Strong attention to detail with a high level of accuracy.
• Strong organizational and time management skills.
• Excellent analytical, communication, and collaboration skills.
• Experience with EHR systems (e.g., Epic, Cerner) and data analytics tools is a plus.
• Knowledge of payer contract language and reimbursement methodologies.
• Understanding of risk adjustment models (e.g., HCC, MS-DRG).
• Ability to interpret clinical documentation and translate it into coding and billing

language.

Wage Starts at $27.00 and goes up with experience

Immunizations required for employment

Benefits

FHW offers a full benefits package including:

FOR ALL EMPLOYEES:

Employee Assistance Program

403 (B) with 4% match from FHW and zero day vesting schedule

FOR FULL TIME EMPLOYEES WORKING AT LEAST 30 HOURS A WEEK

Medical Plan Options:

I. PPO plan with copay/coinsurance and lower deductible

II. High Deductible Health Plan with the option for a Health Savings Account.

III. Telemedicine includes in both plan options.

Dental

Vision

Life Insurance/ Accidental Death and Dismemberment Insurance

Disability Insurance with a Short and Long Term Option.

Critical Illness and Accident Plans

Cafeteria Options: Health Reimbursement/ Flex Savings / Dependent Childcare

A host of other options to include: Pet Insurance, Identity Protection, Travel protection,