Clinical Documentation Improvement Specialist

Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:
Full-time remote location Certified Coding Specialist with a high level of clinical proficiency necessary for the review processes of complex pediatric patients in accordance with all current payer initiatives and development 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; an ability to analyze and interpret medical record documentation and formulate appropriate physician queries; and an ability to benchmark and assist in analyzing clinical documentation program performance.

From a full-time remote location, exhibits a sufficient knowledge of clinical documentation, ICD coding/reporting requirements, APR-DRG assignment, and clinical conditions or procedures impacting severity of illness, risk of mortality, and/or data quality.

Facilitates complete and accurate documentation and coding of inpatient medical records on a concurrent and retrospective basis by serving as a resource for HIM coders and physicians regarding proper documentation practices and the link to ICD codes and APR-DRG assignments.

Educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management.

Collaborates with interdisciplinary teams including, but not limited to, 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 to provide accurate data necessary for reporting, development, and processes.

Maintains professional development by participating in workshops, conferences, and/or in-services keeping appropriate records of participation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Maintains utmost level of patient confidentiality.
• Adheres to hospital policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Completes initial reviews timely in order 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 to determine an accurate working and final APR-DRG, severity of illness, and/or risk of mortality.
• 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.

EDUCATION AND/OR EXPERIENCE:
RHIA, RHIT, CCS, CDIP, or CCDS certification with a minimum of two years ICD hospital-based coding experience, or are clinical candidates credentialed 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.
 

CERTIFICATES, LICENSES, REGISTRATIONS
RHIA, RHIT, or CCS certification required or eligible – to be achieved within 1 year of employment. CDIP or CCDS certification required or eligible – to be achieved within 1 year of employment.