CDI Specialist

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

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ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Job Requisition – CDI specialist/Clinical Auditor (Offshore / India)

Job Title

CDI specialist/ Clinical Auditor – Offshore (India)

Job Summary

The DRG Auditor (Offshore) is responsible for performing high‑quality inpatient DRG audits to ensure accurate MS‑DRG assignment in compliance with ICD‑10‑CM/PCS coding guidelines, CMS regulations, and client‑specific requirements. This role supports onshore teams by validating coding accuracy, CC/MCC capture, and documentation sufficiency to ensure reimbursement integrity and audit readiness.

Key Responsibilities

• Perform retrospective inpatient DRG audits for U.S. hospital accounts
• Validate principal diagnosis, secondary diagnoses, procedures, and DRG assignment
• Review charts for accurate CC/MCC capture, SOI/ROM, and clinical validity
• Ensure compliance with ICD‑10‑CM/PCS Official Coding Guidelines, Coding Clinic, and CMS regulations
• Identify DRG shifts, missed diagnoses, and documentation‑related issues
• Provide clear audit findings with supporting clinical and coding rationale
• Document audit results accurately in client‑specified tools or templates
• Collaborate with onshore auditors, CDI, coding, and quality teams
• Meet established productivity, quality, and turnaround time metrics
• Participate in calibration sessions, feedback reviews, and ongoing training

Required Qualifications

• Clinical or coding credentials: RN/ MBBS/ BDS/ BAMS/ BHMS, CCS or CPC, CCDS or CDIP
• 2+ years of inpatient coding and DRG validation experience

·         Knowledge of CDI concepts and physician documentation standard

• Strong knowledge of:
  • MS‑DRGs
  • CC/MCC logic
  • SOI/ROM concepts
  • Principal diagnosis and sequencing rules
• Hands‑on experience auditing inpatient charts for U.S. healthcare facilities
• Solid understanding of clinical documentation and coding compliance
• Strong written and verbal English communication skills

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.