Job Description
Job Title: Manager, Clinical Documentation Integrity (CDI) & DRG Denials
Are you passionate about driving excellence in clinical documentation and leading high-performing teams? We are seeking a Manager of Clinical Documentation Integrity (CDI) & DRG Denials to lead our CDI department and oversee the DRG denials appeals process within a growing, award-winning health system serving a diverse community in the beautiful Hudson Valley.
This is an opportunity to join a patient-centered, forward-thinking organization where collaboration, innovation, and quality care are at the core of everything we do.
Key Responsibilities
- Lead the day-to-day operations of the CDI department and DRG denials process.
- Develop, implement, and evaluate policies and procedures related to clinical documentation improvement across multiple hospital sites.
- Ensure medical record reviews are conducted to assess appropriateness and medical necessity for admission and continued stay.
- Facilitate improvement in the quality, completeness, and accuracy of medical record documentation.
- Collaborate closely with outcomes managers and coding denial coordinators to review and write compelling appeals for third-party denials.
Qualifications
✅ Education:
- Bachelor’s Degree in Nursing (required).
✅ Experience:
- Minimum 5 years of progressive experience in an acute care hospital (100+ beds).
- Minimum 5 years of experience in the CDI industry.
- Strong knowledge of ICD-10 diagnosis coding, CPT coding guidelines, DRG-based reimbursement, and DRG/coding appeal process.
- Exceptional communication skills with physicians and clinical staff.
✅ Licenses/Certifications:
- Current NY State RN license (required).
- Certified Clinical Documentation Specialist (CCDS) credential (required).