CDI Quality Reviewer; Remote

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency.

If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

The Clinical Documentation Integrity (CDI) Quality Reviewer responsibilities include comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, act as a liaison between coding and CDI to resolve Diagnosis-Related Group (DRG) or other code discrepancies, collaborate with CDI educator to educate CDI team based on opportunities identified in second level reviews and work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and/or provider education.

The CDI Quality Reviewer will collaborate closely with Coders, Coding Quality Auditors, Quality Department and Providers to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards. Typically reports to the CDI Quality/Education Manager.

Education:

Bachelor's of Nursing, required;
Master’s Degree in Nursing or Management preferred.

Licenses/Certifications:

Current State of Texas license or temporary/compact license to practice professional nursing

One of the following is required:

• Certified Clinical Documentation Specialist (CCDS) from the Association of Clinical Documentation Improvement Specialists
• Certified Clinical Documentation Integrity Professional (CDIP) from the American Health Information Management Association (AHIMA)
• Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA)

• Three (3) years of Clinical Documentation Integrity (CDI) experience required
• Approved AHIMA ICD-10-CM/PCS Trainer preferred
• Previous CDIS auditing, denial and Vizient experience preferred
• Strong computer proficiency including working knowledge of MS Office
  - Word, Excel and Outlook and 3M Coding and Reimbursement software; experience with Epic EMR preferred
• Excellent communication, analytical and problem-solving skills are essential
• Strong organizational skills and must be detail oriented
• Highly analytical with strong risk assessment, impact analysis and problem- solving skills
• Highly self-motivated, yet demonstrate ability to be a team player and take direction
• Flexible and able to multi-task and prioritize daily workload, performing concurrent chart reviews as needed

• Completes comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and/or code discrepancies; mortality reviews to ensure documentation supports risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnoses as identified for potential missed opportunities to clarify documentation or clinically validate a diagnosis.
• Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for a Compliant Query Practice.
• Acts as a liaison between the Coding Department and Clinical Documentation Integrity to reconcile discrepancies in code and/or DRG assignment.
• Communicates findings of secondary reviews to Manager.
• Collaborates with CDI Educator/Auditor when educational needs are identified from second level reviews.
• Researches, investigates and remains up to date on both clinical and coding guidelines…