HIS - CDI Specialist

PURPOSE OF THIS POSITION

The primary purpose of the Clinical Document Integrity (CDI) Specialist position is to improve the quality of provider documentation in order to effectively translate into accurate coded data which is representative of the patient’s episode of care/intensity of service. The objective is to ensure the integrity and quality of the data reported is supported by provider clinical documentation to accurately reflect reimbursement and quality reporting which influences provider and hospital profiling.

• Duty 1:
  Analyze clinical documentation in an inpatient and/or outpatient setting to identity documentation improvement opportunities which may have an impact on coding, quality reporting and/or reimbursement outcomes. Provides recommendations to improve identified opportunities or risks.
• Duty 2:
  Provides or coordinates education to healthcare providers regarding the importance of accurate and complete documentation in the health record and impact on quality of data and impact on reimbursement, quality metrics, and continuity of care. This includes attendance and presentation to necessary medical staff committees, individual education, and written communication (e.g. letters, newsletters, etc.).
• Duty 3:
  Performs concurrent review of inpatient medical record to identify documentation improvement opportunities related to coding and quality initiatives. Interacts with providers through written queries and/or verbal communication as appropriate. Support HIS Coding team on retrospective query process and interacts with provider to facilitate resolution, as needed.
• Duty 4:
  Partners with the HIS coding team to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine working and final DRG, severity of illness and/or risk of mortality.
• Duty 5:
  Participates in third party payer audits and assists in defending clinically focused take-backs and in the appeal process. Supports resolution of identified issues; documents relevant decisions related to CDI/clinical practice in policies or procedures to promote ongoing standardization and consistency.
• Duty 6:
  Partner with HIS coding teams and other key areas to insure an accurate and compliant picture of clinical care per the clinical documentation to support compliant coding and accurate reimbursement.
• Duty 7:
  Analyzes and trends statistical data of internal practices and industry resources (e.g. PEPPER report, Integrity Audit issues, RAC, OIG, Health grades, etc.) to identify documentation improvement opportunities and makes recommendations to address issues.
• Duty 8:
  Support organizational initiatives impacted or dependent on the quality of clinical documentation; this may include performing chart reviews, educating departments or teams, participating in Performance Improvement events, provide support to other areas (such as Case Management, Quality, UR), participate in HCIS-related projects, member of committees or task force, etc.

• Associate’s degree in a related field including, but not limited to nursing or other clinical professions, or 4+ years’ experience from which comparable knowledge and abilities have been acquired.
• Registered Nurse (RN), Registered Health Information Administrator (RHIA), or other clinical certification/licensure.
• Certification in CDI (CCDS or CDIP) required; or eligible and achieved within 24 months of hire date.
• Proficient knowledge of ICD-10/DRG, CPT/APC classification systems, IPPS and OPPS reimbursement methodologies and Regulatory Compliance required.
• Ability to compile, analyze an effectivity present data and complex information in an informative and meaningful way to a variety of audiences, including medical providers and leadership.
• Advanced technical aptitude, proven proficiency with computers and commonly used software applications, including MS Office Suite, internet, electronic health record, and health care-related applications, including 3M Encoder.
• Positive service-orientated interpersonal and communication skills required to effectively interact with physicians, case managers, coders, clinical departments.…