CDI Compliance Manager

POSITION SUMMARY:The CDI Compliance Manager serves as a resource for expert knowledge in clinical documentation integrity and compliance. They ensure adherence to Federal and State regulations, reimbursement guidelines, and organizational policies. The role involves managing CDI audits, providing education to clinical staff, and ensuring compliance with documentation standards. They collaborate with physicians, CDI specialists, and coding teams to optimize documentation practices, ensuring accurate capture of patient acuity, severity of illness, and risk of mortality.ESSENTIAL FUNCTIONS:To perform this job successfully, an individual must perform each essential function satisfactorily with or without reasonable accommodation.• Compliance Audits & Monitoring (50%)• Develops and implements a CDI compliance audit program, focusing on clinical documentation integrity, completeness, and accuracy.• Conducts internal audits of clinical documentation and CDI practices to ensure compliance with regulatory standards, including IP ICD-10-CM and PCS coding guidelines and teaching physician rules.• Collaborates with coding teams to identify discrepancies between clinical documentation and coded data, recommending corrective actions.• Education & Training (30%)• Provides training to CDI staff, physicians, and healthcare providers on documentation standards and compliance requirements.• Organizes educational sessions on clinical documentation best practices and updates on relevant CDI guidelines.• Partners with SMEs to develop educational materials for internal medicine sub-specialties.• Collaboration & Support (20%)• Collaborates with physician advisors, CDI teams, and coding professionals to optimize documentation templates and processes.• Facilitates regular meetings with clinical and coding teams to discuss compliance updates, audit results, and improvement opportunities.• Ensures documentation aligns with third-party billing guidelines and government regulations to avoid compliance risks.KNOWLEDGE, SKILLS & ABILITIES:• Comprehensive knowledge of CDI practices, IP ICD-10-CM and PCS coding, clinical documentation, and inpatient chart reviews.• Strong understanding of Federal and State reimbursement regulations, including DRG/MSDRG methodologies.• Ability to audit and interpret clinical documentation for completeness, accuracy, and compliance.• Proficient in EHR systems for clinical documentation management.• Excellent communication and training skills to educate clinicians and CDI staff on compliance requirements.• Detail-oriented with the ability to analyze and resolve compliance-related issues.EDUCATION & EXPERIENCE:• Education:• Minimum Bachelor's degree in Nursing, Health Information Management, or a related field; Master's preferred.• Experience:• Minimum 5 years of experience in CDI, with at least 3 years in a compliance or audit role.• Certifications & Licenses:• Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) required.• RHIA, RHIT, or CCS certification preferred.