[Hiring] Clinical Documentation Integrity Specialist @University Hospitals

Role Description

The Clinical Documentation Integrity Specialist is responsible for utilizing independent clinical judgement in facilitating the integrity, overall quality, accuracy, and completeness of provider-based clinical documentation in the medical record. This position is responsible for collaborating with healthcare providers to ensure the documentation in the medical record accurately reflects the patient. The CDI Specialist assesses the clinical documentation through extensive review of the medical record, interacts with multiple members of the healthcare team, educates and assists the clinical areas in effective and compliant documentation. The CDI Specialist provides guidance with processes in the clinical departments to support accurate, timely, and complete documentation in agreement with company policies and procedures.

Qualifications

• Associate's Degree in health related field or Other Accredited Program: Diploma in Nursing (Required)
• Bachelor's Degree in health related field (Preferred)

Requirements

• 3+ years clinical and/or ICD-10 coding experience, preferably in a large academic medical center (Required)
• 1+ years Experience using clinical computer systems (Required)
• Must have thorough, up-to-date clinical skills (i.e. current working knowledge of pathology, pharmacology, surgical procedures, etc.) (Required proficiency)
• Excellent written and verbal communication skills including presentations (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment (Required proficiency)
• Detail-oriented, and relationship building skills (Required proficiency)
• Demonstrates and has extensive knowledge of disease pathophysiology (Required proficiency)

Additional Responsibilities

• Performs review of facility inpatient encounters to ensure hospital case-mix index and severity profiles are accurate by performing timely medical record review, determination of working DRG assignment and applying clinical expertise to identify opportunities for improved or clarified documentation that accurately reflects the severity of illness and risk of mortality of the patient.
• Demonstrates proficiency in establishing and reconciling DRG processes compliant with departmental guidelines and CMS regulations.
• Demonstrates proficiency in reviewing increasingly complex (SOI and ROM) cases.
• Participates in service line rounding/touch-point routinely, based on facility needs.
• Identifies HAC/PSI query opportunity utilizing resources and follows department guidelines for HAC/PSI query processes.
• Comprehends the impact of accurate clinical documentation in the medical record beyond establishing a working DRG: accurate billing, public reporting, research data, quality metrics, provider scorecards, accuracy of the UHDDS, Case Mix Index (CMI).
• Demonstrates skills of high efficiency and accuracy to identify and reduce DRG downgrades/denial risks by assuring that clinical support is beyond dispute for DRG integrity, coding and billing needs.
• Performs review of facility outpatient encounters identified as potentially missing charges and conducts additional research to help resolve the areas of opportunity and identify the root cause of the issues causing the missed charges.
• Coordinates with clinical departments including Coding, CDM, Finance and others to review, correct claims and identify root cause of missing charges.
• Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities, summarizes data and prepares summary materials for discussion with clinical and finance teams.
• Develops and maintains project plans and project tracking, including documentation of project meetings and project issues lists.
• Work with finance to track revenue indicators and corresponding action plans.
• Auditing and monitoring of defined areas.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients.

Licenses and Certifications

• Registered Nurse (RN), Ohio and/or Multi State Compact License (Required Upon Hire)
• Registered Health Information Administration (RHIA) (Required Upon Hire)
• Registered Health Information Technologist (RHIT) (Required Upon Hire)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently