CDI Lead Specialist

Job Summary

JOB SUMMARY

Educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management. Assists with overseeing department workflow and metrics. Educates and trains department staff. Responsible for reviewing medical records to facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient.

Include the following. Others may be assigned.

• Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to: (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate MS-DRG assignment, risk of mortality and severity of illness; and (b) initiate a review in host system.
• Conducts follow-up reviews of patients every 1-3 days to support and update the working MS-DRG, as necessary.
• Formulates physician queries due to missing, unclear or conflicting documentation as necessary.
• Collaborates with providers, case managers, nursing staff and other ancillary staff to assist in resolving physician queries prior to discharge.

• Provides daily support/mentoring/training to new CDI hires as well as existing CDI staff.
• Provides assistance in managing escalated issues and special projects as needed to supervisors and managers. CDI staff coverage as necessary
• Performs concurrent and/or retrospective CDI reviews as necessary
• Provides CDI support/mentoring/training to Physicians and hospital leadership as necessary.
• Enters facility specific data to dashboards as necessary

3. Resolves problems, concerns and reports issues with Operations to Supervisor,Manager or Director. Assists with orientation of new CDI Staff

• Completes yearly required learn shares
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD coding.
• Attends mandatory coding sessions on annual basis (IPPS and ICD updates) for inpatient coding.
• Quarterly review of AHA Coding Clinic.
• Attends Quarterly Coding Updates and all coding conference calls as well as any required CDI education.

5. Provider Engagement:
Conducts provider rounding, provides education, and communicates with providers on documentation and physician query opportunities as appropriate for follow up and resolution.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Must display teamwork and commitment while performing daily duties
• Must demonstrate initiative and discipline in time management and medical record review
• CDI Subject Matter Expert with Advanced knowledge of Medicare Part A and familiar with Medicare Part B
• Intermediate knowledge of disease pathophysiology and drug utilization
• Intermediate knowledge of MS-DRG classification and reimbursement structures
• Critical thinking, problem solving and deductive reasoning skills
• Effective written and verbal communication skills
• Knowledge of coding compliance and regulatory standards
• Excellent organizational skills for initiation and maintenance of efficient workflow
• Capacity to work independently in a virtual office setting or at facility setting if required to travel for assignment.
• Understand and communicate documentation strategies
• Recognize opportunities for documentation improvement
• Formulate clinically, compliant credible queries
• Ability to comply with an auditing and monitoring program as a means to measure query process
• Ability to apply coding conventions, official guidelines, and Coding Clinic advice to health record documentation
• Must be able to resolve issues effectively and provide recommendations and solutions
• Effectively explain processes and educate others
• CDS SME with ongoing education with physicians and facility leaders
• CDI facility representation for hospital and physician meetings
• Local facility mentorship for CDI team support and effectiveness
• CDI staff coverage as necessary
• Gathering additional data as needed for supervisor, manager and…