CDI Lead Specialist - Saint Joseph Hospital East

Job Summary

Educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management. Assist with overseeing department workflow and metrics. Create reports used to make strategic decisions. Educate and train 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, by improving the quality of the physicians’ clinical documentation.

• 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 worksheet.
• Conducts follow-up reviews of patients every 2-3 days to support and assign a working or final MS-DRG assignment upon patient discharge, as necessary.
• Formulate physician queries regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the health record, as necessary.
• Collaborates with case managers, nursing staff and other ancillary staff regarding interaction with physicians regarding documentation and to resolve physician queries prior to discharge.

• Provides daily support/mentoring/training to new hires as well as existing staff.
• Provides assistance in managing escalated issues and special projects as needed to supervisors and managers. CDI staff coverage.
• Performs concurrent and retrospective CDI audits.
• Provides CDI support/mentoring/training to Physicians and hospital leadership as needed.
• Completion of scrubbing and submitting monthly data to vendor.
• Enters facility specific data to dashboards.
• Resolves problems, concerns and reports issues with Operations Supervisor, Manager or Director.

• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding.
• Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding.
• Quarterly review of AHA Coding Clinic.
• Attends Quarterly Coding Updates and all coding conference calls as well as any required CDI education.

• Communicates/Completes Clinical Documentation Improvement (CDI) activities and coding issues (lacking documentation, physician queries, etc.) for appropriate follow-up and resolution.

• 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 maintain 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 teach others to follow them.
• CDS SME with ongoing education with physicians and facility leaders.
• CDI facility representation for hospital and…