Health Information Management CDI Quality Analyst II

Location:

Moody Outpatient Center

Primary Purpose

Serves as operational support and knowledge expert for the Clinical Documentation Integrity(CDI) team. Serves as the primary CDI contact for the physician/provider staff in troubleshooting query issues and explaining the importance of documentation integrity. Helps ensure that departmental CDI practices adhere and comply with the professional practice standards as identified by the American Health Information Management Association (AHIMA)/Association of Clinical Documentation Integrity Specialists (ACDIS) Query Practice Brief as well any internal policies.

Minimum Specifications

Education

• Must have a Bachelors Degree in Nursing from an accredited college or university OR
• a graduate of a Health Information Management program OR
• Medical School graduate with a Master's Degree in a Healthcare/Medical related field from an accredited university

Experience

• Must have five years experience as a Clinical Documentation Integrity Specialist with two years of completing quality reviews and/or audits of CDI activities

Equivalent

Education and/or Experience

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Certification/Registration/Licensure

• Because of the lag in SCCE, HCCA, NCRA, and AHIMA updating the status of certifications, current employees whose certification is granted through one of these associations are allowed up to seven (7) calendar days, after expiration, to provide proof of renewal. Although an additional seven (7) calendar days is allowed to provide proof of renewal, there cannot be a lapse in the certification's 'active' status.
• Must have either a Certified Clinical Documentation Specialist (CCDS) certification OR
• Must have a Clinical Document Improvement Practitioner (CDIP) certification.
• For RNs:
  Must have a current RN license or valid temporary permit with the Texas board of Nursing; or valid compact RN license
• For HIM Professionals :
  Must have one of the following current certifications:
• Certified Coding Specialist (CCS)
• Registered Health Administrator (RHIA)
• Registered Health Information Technologist (RHIT)

Skills or Special Abilities

• Must have strong clinical skills and be able to apply this knowledge in record review and analysis to identify opportunities for documentation clarification.
• Must have a strong working knowledge of ICD-10-CM/PCS, inpatient coding guidelines, MD-DRG concepts and the SOI/ROM impact on the Medicaid population (APR-DRG).
• Must have a strong working knowledge of clinical quality measures as related to documentation, such as: HACs, PSIs, PPCs, SOI and ROM.
• Must have the knowledge and ability to interpret relevant guidelines and regulations and effectively apply in CDI practice and query composition.
• Must be able to employ effective problem solving skills to make appropriate recommendations for process improvement.
• Must be able to write detailed reports of findings and recommendations.
• Must demonstrate effective interpersonal and communication skills.
• Must demonstrate ability to utilize CDI software, navigate the EMR as well as demonstrate a working knowledge of MS Office applications (Word, Excel, PowerPoint, database, SharePoint).
• Must demonstrate sufficient leadership skills to be able to provide guidance to staff when management is unavailable.

Responsibilities

• Assists with leading continuous improvement in CDI development and deployment of standard policies and procedures, standardized queries, technologies and tools, and strategies targeted to improve the quality of documentation and overall quality and financial performance.
• Assists in providing oversight and monitoring of the CDI daily workflow - helps coach staff, facilitate and solve work problems.
• Performs second level reviews for the CDI staff for query analysis and and compliant query composition.
• Serves as the Subject Matter Expert (SME) for any topics related to provider documentation as well usage of the CDI software functionality.
• Participate in other coding quality/DRG/CDI projects as assigned.
• Analyzes the unassigned notifications and sends queries when needed.
• Performs final review of pending queries for accuracy and need for final escalation.
• Answers CDI staff questions regarding coding issues, DRG assignment as well as clinical and quality inquiries related to documentation.
• Serves as main point of contact and interacts with physician/provider staff in troubleshooting query issues and explaining the importance and impact of documentation integrity .
• Collaborates with HIM Informatics in performing test scenarios for CDI software upgrades/updates or new functionality.
• Serves as liaison with the Coding Quality Review team and participates and provides input in QMR sessions.
• Helps ensure that CDI staff adhere and comply with the professional practice standards as identified by the American Health Information Management Association (AHIMA)/Association of Clinical Documentation Integrity Specialists (ACDIS) Query…