Program Integrity Director Jobs in Birmingham, AL

In Clinical Documentation Integrity at Main Campus Lee Building
Work schedule will be Full-time on the Day Shift, 8-4:30.
Summary:
The Clinical Documentation Integrity (CDI) Nurse Coordinator position is an experienced CDI Specialist who works in partnership with the CDI Manager/Director, Lead Coders, Physician Adviser, and Billing Department to help ensure high quality and production standards are met through secondary reviews and denials management. The CDI Coordinator is responsible for maintaining concurrent and retrospective review expertise to ensure accuracy, specificity, and severity captures are obtained consistently by all reviewers. This role will work closely with all levels of leadership, subject matter experts, and operational stakeholders to remain compliant with state and federal regulatory codes and guidelines.
The CDI Coordinator will also perform advanced-level work related to clinical denials management. The individual is responsible for managing medical denials by conducting a comprehensive review of clinical documentation and writing clinical-based appeal letters. They will review inpatient and outpatient coding and documentation and clinical denials to validate reasons, ensuring accurate diagnosis and procedure coding. This position will research, write compelling clinical-based appeal letters for denied services based on the clinical documentation and the medical policies of the payor and submit the appeal in a timely manner.
The CDI Coordinator is expected to participate in the education and onboarding process of all new hires and perform duties and conduct interpersonal relationships in a manner that promotes a team approach and collaborative work environment with physicians, CDI staff, Coders, and Billing Department. This position will also participate in various projects and initiatives within the CDI Department.
Other information:
Competencies

• Strong computer skills with the ability to work in multiple computer programs.
• Excellent customer service skills via phone, email, and face-to-face interactions.
• Ability to communicate patient information written and verbally to appropriate parties while maintaining patient privacy standards; communicates clearly and effectively.
• Ability to organize and manage time effectively; prioritize requests when appropriate.
• Ability to multi-task and remain focused while managing a high volume, time-sensitive workload.
• Active listening and critical thinking skills. • Ability to work independently.
• Ability to develop and maintain positive working relationships.
• Technologically advanced skills in Microsoft products - Word/Excel/PowerPoint
• Attention to detail and strong organizational skills

Education:

• Bachelor's degree in nursing preferred

Experience:

• At least five years of CDI Specialist experience required with pediatric CDI experience preferred
• Knowledge of Coding (ICD-10, CPT) required
• CCDS and/or Coding certification (ex. CPC) highly desired or willingness to complete after employment
• Experience in EPIC EMR preferred

Credentials:

• Current RN in the State of Alabama required

Credentials with Equivalent Qualifications:
Essential:
* Registered Nurse AL Single State or any of the following equivalent qualifications below:
- Registered Nurse AL NLC Multi State
- Registered Nurse Non-AL NLC Multi State
Education with Equivalent Qualifications:
Nonessential:
* Bachelor of Science Nursing in Nursing
Experience with Equivalent Qualifications:
Essential:
* 5 Years job experience as Staff Level with specialization in the field of Nursing Acute
The Clinical Documentation Integrity (CDI) department plays a key role within the Revenue Cycle by ensuring the accuracy and integrity of clinical documentation and related processes. The department encompasses several specialized areas: Inpatient and Outpatient CDI, Infusion Prior Authorizations, Medical Audit, and Medicaid Screening. Each area is staffed by experienced nurses who review medical records for various clinical and regulatory purposes. Inpatient and Outpatient CDI Nurses conduct concurrent and retrospective reviews of medical records to ensure documentation accurately reflects the patient's clinical status, severity of illness, and treatments. Their work supports appropriate coding, reimbursement, and compliance, while also providing ongoing documentation education to physicians and clinical staff. Infusion Prior Authorization Nurses manage prior authorization requests for outpatient infusions, including those requiring peer-to-peer reviews or appeals. They collaborate closely with Billing on denials and appeals to support timely patient care and reimbursement. Medical Audit Nurses perform chart audits to ensure hospital charges are appropriate and compliant. They identify billing trends, correct discrepancies, and support hospital departments with charge integrity. Medicaid Screening Nurses focus on EPSDT and Interperiodic Screenings for patients with Medicaid coverage. Their detailed reviews ensure compliance with state and federal Medicaid regulations. Together, these teams support clinical excellence, regulatory compliance, and financial sustainability through comprehensive documentation and review processes.