[Hiring] CDI Lead Specialist @Conifer Health Solutions

Role Description

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.

Essential Duties and Responsibilities

• Record Review:
  • Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to evaluate documentation for accurate MS-DRG assignment.
  • 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.
• Lead Responsibilities:
  • 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.
  • 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.
• Resolves problems, concerns and reports issues with Operations to Supervisor, Manager or Director. Assists with orientation of new CDI Staff.
• Professional Development:
  • Completes yearly required learnshares.
  • Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD coding.
  • Attends mandatory coding sessions on an 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.
• Provider Engagement:
  • Conducts provider rounding, provides education, and communicates with providers on documentation and physician query opportunities as appropriate for follow up and resolution.
• Other duties as assigned.

Knowledge, Skills, Abilities

• 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 familiarity 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.
• Gathering additional data as needed for supervisor, manager and director.

Education / Experience

• Preferred: Two (2) or more years’ experience in CDI.
• Graduate from a Nursing program, RN, BSN, Medical Doctor, Foreign Medical Doctor, and/or graduate of Health Information Management RHIT, RHIA preferred.
• Preferred: Two (2) years’ experience with either HIM/Coding or Case Management experience.

Certificates, Licenses, Registrations

• Required: RN, Medical Doctor, Foreign Medical Doctor, or RHIT, RHIA, and/or CCS.
• Preferred: CDIP or CCDS.

Physical Demands

• Ability to sit for extended periods of time.
• Must be able to efficiently use computer keyboard and mouse.
• Good visual acuity.

Work Environment

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Other

• Must be able to travel as needed, not to exceed 10%.

Compensation and Benefits

• Pay: $81,952 - $122,907 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.
• Medical, dental, vision, disability, life, and business travel insurance.
• Paid time off (vacation & sick leave) – min of 12 days per year, accrued at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match.
• 10 paid holidays per year.
• Health savings accounts, healthcare & dependent flexible spending accounts.
• Employee Assistance program, Employee discount program.
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.