Providence St. Joseph Health

Job Information

Providence Health & Services Clinical Documentation Quality Improvement (CDQI) Auditor in Santa Monica, California


Providence is calling a Clinical Documentation Quality Improvement (CDQI) Auditor (Full Time/Day Shift) to Providence California Regional Services in Santa Monica, CA.

We are seeking a Clinical Documentation Quality Improvement (CDQI) Auditor who will be responsible on improving the overall coding and DRG accuracy through enhancing clinical documentation and improving the quality of patient data utilizing a pre-bill review process (prior to bill submission for payment, the auditor performs coding and DRG assignment and quality reviews on inpatient records within 2-5 days of discharge and before billing occurs) and/or monthly post discharge quality audits on inpatient and outpatient cases. This role is vital in supporting the validity and accuracy of ICD-10 coding, MS-DRG, APR-DRG (SOI, ROM), PSI, POA, HAC assignment, mortality O/E ratios (and PPR, PPC, if/when applicable) in compliance with all Federal and State coding regulations and reporting requirements and also works collaboratively with CDI, Coding, physicians, quality and other key hospital personnel to ensure proper quality reporting of data.

In this position you will:

  • Facilitate appropriate clinical documentation to ensure that the overall quality, level of services, severity of illness, and acuity of care are accurately reflected in a complete medical record, yielding the appropriate reimbursement for the level of services rendered and resources consumed

  • Be essential in supporting the Hospital Value-Based Purchasing (VBP) results, by reviewing documentation to ensure accuracy in the Potentially Preventable Readmissions (PPR), Patient Safety Indicators (PSI), Hospital Acquired Conditions (HAC), Present on Admission (POA) conditions, and Mortality reviews to avoid penalties associated with lack of proper documentation

  • Maintain dynamic communication with coders and CDI personnel to identify root cause of CDI-Coder final DRG mismatch and seek to resolve incongruence with appropriately assigned final DRG

  • Analyze provider data in concurrence with the CDI Physician Educator, looking for individual, group, and peer outlier trends that could benefit from additional education. Convey support and education as needed to providers focused on improving processes and the quality of their documentation on a case-by-case basis to accurately reflect patient care in the medical record

  • Work collaboratively with Quality department to not only improve documentation for quality reporting, but to report on trends associated with documentation to ensure continued improvement

  • Monitor and track impact related to Observed/Expected (O/E) mortality selected focused DRGs or other specific areas in collaboration with quality

  • Assist coding by placing retro-queries to obtain vital documentation and follows up with physicians to educate and engage them with proper responses to obtain quality documentation and data. Provider feedback may be distributed through face-to-face education, attending practice group meetings, medical directors and formal medical staff committees regarding the status and trends of the integrity of their documentation

  • Review coded documentation to ensure proper code assignment and send through proper billing process timely to avoid any delays in DNFC/DNFB


Required qualifications for this position include:

  • RN or a Bachelor of Science degree in healthcare administration or other related field


  • Works at maintaining a cooperative working relationship with staff and clinical departments

  • Maintains organizational, employee and patient confidentiality at all times

  • 7-10 years of CDI and/or HIM experience

  • Strong background with auditing coding and CDI cases and understanding the differences between coding and clinical language.

  • Professional systems application experience

  • Experience with data tracking, and various CDI systems (i.e. Epic, 3M, Iodine)

  • Experience working in or with Patient Financial Services and Accounting. Knowledge of Medicare, Medicaid and other third party billing rules and regulations

  • Skilled in clinical documentation, charging, billing compliance and coding including MS-DRG, APR-DRG, ICD-10, Revenue, CPT and HCPCS codes

  • Strong experience and understanding of quality metrics and risk adjustment impacts (SOI/ROM, HAC, PSI, Mortality O/E)

  • Excellent written, analytic problem solving, human relations and communication skills

Preferred qualifications for this position include:

  • At least 5 years working in an inpatient setting focused on CDI and/or hospital coding (DRG methodology)

  • Knowledge of ICD-10 and its impact on providers

About the hospital you will serve. Anchored by five award-winning comprehensive medical centers, Providence provides a full spectrum of care that includes a range of specialties, signature services, outpatient and home care and the well-regarded Providence Medical Institute, a group of physicians and primary and urgent care clinics throughout the greater San Fernando Valley and South Bay. Providence is focused on providing the communities it serves with preventive care, education and leading-edge diagnostics and treatment. The organization includes numerous outreach programs. Hospice and home care and even our own Providence High School, a Blue Ribbon college-preparatory campus.

We offer a full comprehensive range of benefits - see our website for details

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Case Management

Location: California-Santa Monica

Req ID: 242868

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