CDI Reconciler Tufts Medicine

About Tufts Medicine

Tufts Medicine brings together the best of academic and community medicine to deliver exceptional, connected and accessible care. Comprised of Tufts Medical Center, the principal teaching hospital of Tufts University and the Tufts University School of Medicine, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home, and an integrated network of 2,300 physicians, we treat the most complex conditions, keep our communities healthy and bring research breakthroughs to life.

Location: Remote

Job Overview

This position independently evaluates complex clinical documentation and coding issues, exercises professional judgment in resolving documentation and coding discrepancies, interprets regulatory guidance, and provides expert recommendations that influence organizational documentation integrity, quality reporting, compliance, and reimbursement practices. The position serves as a subject matter expert for CDI reconciliation and contributes to policy development, process improvement, and organizational decision-making.

Working collaboratively with CDI specialists, coding professionals, physicians, advanced practice providers, and Health Information Management (HIM), this position analyzes documentation and coding differences, identifies trends, and provides feedback to promote consistency and documentation integrity. This position also supports quality improvement initiatives, workflow optimization, performance monitoring, and education to strengthen collaboration between CDI and Coding and ensure the integrity of the health record.

Job Description

Minimum Qualifications:

1. Associate's degree in related healthcare field (nursing, medical billing and coding, healthcare administration).

2. Five (5) years of Clinical Documentation Integrity (CDI) experience in an acute care setting OR Five (5) years' experience as inpatient medical coder.

3. Active, unrestricted Registered Nurse (RN) license in Massachusetts; OR a Nurse Licensure Compact (NLC) state; OR AHIMA Certified Coding Specialist (CCS) credential

Preferred Qualifications:

1. Bachelor's degree in nursing (BSN) or Registered Health Information Administrator (RHIA) credential.

2. Current Certified Clinical Documentation Specialist (CCDS) and/or Clinical Documentation Improvement Practitioner (CDIP) certification.

3. EPIC and 3M/Solventum experience strongly preferred.

Duties and Responsibilities:

The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Independently performs retrospective reconciliation of complex CDI reviews and final coded records, exercising professional judgment to evaluate clinical documentation, coding application, DRG assignment, quality indicators, and regulatory compliance. Determines appropriate reconciliation outcomes and communicate recommendations for resolution.

2. Interprets and applies official coding guidelines, regulatory requirements, and compliant query practices to complex clinical scenarios requiring independent analysis and professional judgment.

3. Collaborates with CDI Specialists, Coding Professionals, Physician Advisors, and Health Information Management (HIM) to resolve documentation and coding discrepancies.

4. Analyzes reconciliation findings to identify systemic documentation, coding, and/or workflow issues; formulate recommendations for improvements and advise CDI and coding leadership regarding any necessary actions.

5. Monitors reconciliation metrics to support program performance, quality improvement, and leadership decision-making.

6. Participates in reconciliation meetings to facilitate collaboration and consensus between CDI and Coding teams.

7. Leads or actively participate in CDI quality initiatives, workflow optimization, policy development, and process improvement activities.

8. Serves as a resource for documentation and coding reconciliation questions and assists with special projects in support of the Clinical Documentation Integrity program.

Physical Requirements:

1. Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.

2. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending / descending stairs, and operate office equipment.

3. Frequently required to speak, hear, communicate, and exchange information.

4. Able to see and read computer displays, read fine print, and/or normal type size print and distinguish letters, numbers, and symbols.

5. Occasionally lift and/or move up to 25 pounds.

Skills & Abilities:

1. Ability to read and write in the English language. Ability to understand and speak English fluently enough to be easily understood by patients, hospital personnel, physicians, and visitors.

2. Strong critical thinking skills and sound clinical background with a working knowledge of disease processes, anatomy and physiology, and treatment regimens.

3. Ability to analyze and interpret clinical information in the patient's medical record.

4. Excellent verbal and written communication skills with strong attention to detail and accuracy.

5. Aptitude to interact confidently and communicate effectively with physicians and other members of the clinical team.

6. Knowledge of ICD-10, AHIMA and Coding Guidelines, healthcare regulations, reimbursement, and documentation requirements.

7. Open, flexible, and adaptable to a changing environment as the CDI industry continues to change and evolve.

8. High level Computer literacy and efficiency with technology, including but not limited to, Microsoft Office Suite (including Word, Excel, Teams), Zoom, Epic, 3M360.

9. Ability to use good judgment in an emergency situation.

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following CDI related duties: Facilitates improvement in overall quality, completeness, and accuracy of medical record documentation, obtains appropriate clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and coding staff to ensure that documentation reflects the level of service rendered to patients is complete and accurate, and serves as a resource to all team members on documentation guidelines, provides guidance and support as well as assisting in the education and training related to improving clinical documentation. A professional individual contributor role that may direct the work of other lower-level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. An experienced level role that applies practical knowledge of job area typically obtained through advanced education and work experience. Works independently with general supervision, problems faced are difficult but typically not complex and may influence others within the job area through explanation of facts, policies and practices.

At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.

The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.

Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth-one of the many ways we invest in you so you can thrive both at work and outside of it.

Pay Range:

based on full-time equivalent