Job Description

Clinical/CDI Second Level Reviewer / Pre-Bill Auditor

Seeking experienced Clinical Second Level Reviewer / Pre-Bill Auditor to support accurate documentation and coding practices that impact reimbursement, quality metrics, and compliance. This role focuses on the pre-bill review of inpatient records, using clinical expertise and advanced technology platformsincluding Iodine AwareCDI or AwareUMto ensure accurate DRG assignment, appropriate clinical documentation, and defensible coding prior to final billing.

Key Responsibilities:

• Conduct clinical validation reviews of inpatient records pre-bill to ensure accurate and compliant DRG assignment.
• Utilize Iodine software tools to identify discrepancies and validate principal diagnoses, secondary diagnoses, procedures, and complications/comorbidities.
• Collaborate with CDI, HIM, and coding teams to resolve discrepancies and clarify documentation prior to claim submission.
• Escalate cases that require further review, physician query, or documentation improvement opportunities.
• Monitor trends, identify recurring issues, and support compliance and quality initiatives.
• Maintain thorough documentation of audit findings and recommendations in alignment with regulatory guidelines and facility policies.

Qualifications:

• RN (preferred) or FMD/IMD (must have at least 3+ years of second level review experience and conversing with CDI)
• 3+ years of CDI or coding experience with a strong focus on inpatient care.
• Experience conducting pre-bill or second level reviews within a hospital or health system.
• Proficient in Iodine Software such as AwareCDI or AwareUM (preferred)
• Working knowledge of MS-DRG/AP-DRG, ICD-10-CM/PCS coding, and clinical guidelines.
• Familiarity with Epic or other major EHR platforms preferred.
• Strong analytical skills, attention to detail, and excellent communication abilities.

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