Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary:

The position reports to the senior leadership and conducts advanced clinical documentation reviews for inpatient encounters to ensure accuracy and compliance with MGB standards and regulatory requirements. This position provides quality assurance for primary CDI reviews, supports accurate code assignment and DRG validation, and ensures optimal reimbursement and data quality for CMS and commercial payors.
Essential Functions

• Identify discrepancies or missed opportunities in clinical documentation that impact the severity of illness, risk of mortality, DRG assignment, and reimbursement through second-level CDI reviews.

• Escalate complex cases to the CDI leadership team or physician advisors, as needed.

• Demonstrate service-line expertise for targeted DRG assignment validation.

• Facilitate communication between vendor-supported primary CDI staff and Coding.

• Perform pre- and post-bill audits to ensure an accurate reflection of the patient’s clinical picture and acuity, with a specific focus on the impact of CMS and commercial payors.

• Provide oversight and quality assurance for the CDI and Coder reconciliation process.

• Manage and track retro-query coding requests to CDI.

• Support the provider query escalation process.

• Identify, monitor, and communicate trends and/or gaps in clinical documentation and/or CDI practices.

• Maintain up-to-date knowledge of inpatient coding guidelines, CDI practices, CMS/OIG regulatory changes, and AHA Coding Clinic.

Qualifications:

Education

• Associate's Degree Nursing, Advanced Degree Nurse Practitioner or Physician Assistant preferred

Licenses and Credentials

• Active and Current Registered Nurse License, Nurse Practitioner License or Physician Assistant License required

Experience

• 5 - 7 years of acute medical/surgical care experience required
• 3 - 5 years of clinical documentation improvement experience required

Knowledge, Skills and Abilities

• Strong knowledge of clinical documentation standards, coding guidelines, and regulatory requirements.
• Excellent analytical and problem-solving skills to assess and improve documentation practices.
• Effective communication and interpersonal skills to collaborate with physicians, coders, and other staff.
• Proficiency in health information systems and electronic medical record platforms.
• Ability to provide education and training to clinical and administrative teams.
• Detail-oriented with strong organizational skills to manage multiple tasks and meet deadlines.

Additional Job Details (if applicable)

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours:

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$79,560.00 - $115,720.80/Annual

Grade

7

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.