CDI Specialist Level II

2 months ago

Tustin, California, United States Prospect Medical Holdings, Inc. Full time
The CDI Specialist Level II is responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate if clinical documentation is reflective of medical necessity, quality of care outcomes and reimbursement compliance for acute care services provided. Works closely with the medical staff to facilitate appropriate clinical documentation of patient care. Other responsibilities include conducting initial and extended-stay concurrent reviews on all selected admissions and documenting findings.

Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders. This is the fulfillment of the hopes Prospect's founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future.

Every day, our more than 11,000 affiliated physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve-many of which provide essential medical services to underserved communities as safety-net hospitals.

Required Qualifications:
  • CDIP or CCDS
  • Medical Graduate, Physician Assistant or Registered Nurse (Current CA License)
  • Minimum 1 year of previous practical floor CDI experience in an acute care setting
  • Ability to multitask and maintain a work pace appropriate to workload
  • Must demonstrate customer service skills appropriate to the job
  • Excellent written and verbal communication skills in English
  • Ability to effectively communicate with physicians in a clear and concise manner
  • Computer literacy and proficiency
  • Hospital Fire and Life Safety Card (Los Angeles City Employees only)

Preferred Qualifications:
  • CCS

Pay Rate: Min - $93,800 | Max - $128,950
  • Reviews inpatient medical records, meeting all department productivity goals, for identified payor populations as directed on admission and throughout hospitalization and identifies potential gaps in physician documentation. Ensures that clinical documentation reflects the level of service rendered to patients in a complete, accurate and compliant manner.
  • Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process, meeting department productivity goals. Follows up with the physicians to get resolution of all queries prior to patient's discharge to ensure accurate quality data and appropriate reimbursement whilst maintaining up to date DRG. Assists coders in follow-up on queries and clarifications to physicians done retrospectively post patient discharge.
  • Coordinates the daily operations of the department, troubleshooting and resolving issues as they occur. Educates others on documentation guidelines on an ongoing basis. Performs as a role model and consistently demonstrates an advanced level of expertise and enhanced communication skills.
  • Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through comprehensive auditing and evaluation of the medical record. Collects and analyzes data to provide reports and make recommendations. Works collaboratively with Performance Improvement Department to improve clinical documentation for compliance in quality of care measures.
  • Performs the duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and all regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
  • Reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician. Follow-up in improving clinical documentation to reduce such denials. Works collaboratively with health information management coding staff, physicians and financial services to resolve payment denials and documentation issues.
  • Regularly participates in scheduled case management meetings and actively exchanges information pertaining to clinical documentation, plan of care affecting coding and reimbursement.
  • Reviews inpatient medical records, meeting all department productivity goals, for identified payor populations as directed on admission and throughout hospitalization and identifies potential gaps in physician documentation. Ensures that clinical documentation reflects the level of service rendered to patients in a complete, accurate and compliant manner.
  • Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process, meeting department productivity goals. Follows up with the physicians to get resolution of all queries prior to patient's discharge to ensure accurate quality data and appropriate reimbursement whilst maintaining up to date DRG. Assists coders in follow-up on queries and clarifications to physicians done retrospectively post patient discharge.
  • Coordinates the daily operations of the department, troubleshooting and resolving issues as they occur. Educates others on documentation guidelines on an ongoing basis. Performs as a role model and consistently demonstrates an advanced level of expertise and enhanced communication skills.
  • Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through comprehensive auditing and evaluation of the medical record. Collects and analyzes data to provide reports and make recommendations. Works collaboratively with Performance Improvement Department to improve clinical documentation for compliance in quality of care measures.
  • Performs the duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and all regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
  • Reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician. Follow-up in improving clinical documentation to reduce such denials. Works collaboratively with health information management coding staff, physicians and financial services to resolve payment denials and documentation issues.
  • Regularly participates in scheduled case management meetings and actively exchanges information pertaining to clinical documentation, plan of care affecting coding and reimbursement.

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