[Hiring] Lead Clinical Documentation Improvement Specialist @DRISCOLL HEALTH PLAN

Role Description

The Lead Clinical Documentation Department Improvement Specialist is a certified coder with a high level of clinical proficiency necessary for leadership of the Clinical Documentation team of licensed nurses and certified coders. This role oversees the review processes of complex pediatric patients in accordance with all current payer initiatives and developments in acute and chronic disease states.

• Understands a wide range of specialized disciplines, including education in anatomy and physiology, pathophysiology, and pharmacology.
• Knowledge of official medical coding guidelines, CMS, and private payer regulations related to the Inpatient Prospective Payment System.
• Ability to analyze and interpret medical record documentation and formulate appropriate physician queries.
• Ability to benchmark and assist in analyzing clinical documentation program performance.
• Facilitates complete and accurate documentation and coding of inpatient medical records on a concurrent and retrospective basis.
• Serves as a resource for HIM coders and physicians regarding proper documentation practices and the link to ICD-10 codes and APR-DRG assignments.
• Collaborates with interdisciplinary teams including physicians, nurse practitioners, PA's, Quality, Case Management, Risk Management, Health Information Management/Coding, Decision Support, product vendors, and other members of the health care team.
• Involved in the direction and education of all phases of the Clinical Documentation process.
• Works in a collegial manner with physicians and support staff.
• Assists management with providing ongoing Clinical Documentation education for current and new staff.
• Maintains professional development by participating in workshops, conferences, and/or in-services.

Qualifications

• RHIA, RHIT, CCS, CDIP, or CCDS certification preferred.
• Minimum of two years ICD hospital-based coding experience or clinical candidates minimally credentialed or above as RN, LVN or BSN with a strong clinical background and a minimum of three years clinical experience in Pediatrics, Med-Surg, ICU, or Surgery.
• Proficient in polished communication skills, Outlook, Word, and Excel.

Requirements

• Always maintains utmost level of confidentiality and integrity.
• Adheres to hospital policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Serves as a subject matter expert for the CDI program, inpatient coding, and reimbursement methodologies.
• Demonstrates ability to educate medical and hospital staff regarding the MS-DRG and APR-DRG reimbursement methodologies.
• Assists HIM management with coordination of CDI compliance reviews.
• Communicates with hospital personnel regarding questions relevant to CDI, inpatient coding, and reimbursement.
• Assists HIM management in communicating with physicians and other clinicians concerning opportunities for improvement relevant to clinical documentation and its impact on reporting.
• Assists HIM management in the development and maintenance of hospital specific CDI, reporting and billing guidelines.
• Attends hospital committee meetings as needed.
• Monitors and evaluates case mix patterns and trends.
• Reviews and codes inpatient medical records as needed for additional backlog and reporting support.
• Assists with special projects as assigned by HIM management.
• Must maintain current knowledge of reimbursement systems and federal, state and payer-specific regulations and policies.
• Must demonstrate continuing education in CDI, inpatient coding, and/or reporting compliance areas.
• Completes initial reviews timely to promptly identify potential documentation improvement opportunities.
• Conducts follow-up reviews of patients as scheduled to support and assign a working or final APR-DRG.
• Queries physicians regarding missing, unclear, or conflicting health record documentation.
• Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record.
• Collaborates with CDI Physician Champion, case managers, nursing staff, and other ancillary staff regarding interaction with physicians on documentation and to resolve physician queries prior to patient discharge.
• Participates in the analysis and trending of statistical data for specified patient populations to identify documentation improvement opportunities.
• Assists with preparation and presentation of clinical documentation monitoring/trending reports for review.
• Partners with the coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to assign ICD-9-CM and ICD-10-CM/PCS diagnosis and procedure codes.
• Assists in the appeal process resulting from third-party reviews.
• Proficiency in the use of Microsoft applications (e.g. Word, Excel, PowerPoint), Epic, and 3M CRS and 3M CDI 360 Encompass.

Company Description