Clinical Documentation Improvement Manager

Job Description

Job Description

Keystone Advisors

is looking for a Clinical Documentation Improvement Manager to join our team in Chicago, IL supporting one of our healthcare clients in the Illinois Medical District.
The

Clinical Documentation Improvement Manager

will complete timely documentation reviews to assign principal diagnosis and pertinent secondary diagnoses for inpatients admitted emergently, urgently and electively and outpatient services for completeness. Work collaboratively with the Clinical Documentation Improvement (CDI) Staff to facilitate documentation within the medical record that supports patients severity of illness and risk of mortality utilizing strong communication skills with physicians, case managers, utilization reviewer, nurse, or other healthcare professionals, utilizing appropriate querying tools to capture needed documentation. Manage audits for external Centers for Medicare & Medicaid Services (CMS) Recovery Audit Tracker (RAC) Audit results. Review monthly audits of all internal coders for accuracy. Using broad knowledge and understanding of the Medical Severity (MS) Diagnosis-Related Group (DRG) system, complication or comorbidity (CC)/major complexity or comorbidity (MCC), impact on quality, and CMI as well as ICD-10-CM/PCS coding systems and the guidelines related to CDI.
Job Duties include but are not limited to the following:
Complete timely documentation reviews to assign principal diagnosis and pertinent secondary diagnoses for inpatients admitted emergently, urgently and electively and outpatient services for completeness.
Use broad knowledge of quality medical documentation and regulatory directives, coordinates point of care and/or retrospective documentation improvement to address severity of illness and risk of mortality and to be further used for patient care, quality of care and performance measurement, and reimbursement. The multi-disciplinary process requires excellent communication and interactive skills with members of the healthcare team.
Serve as a resource to physicians and administration regarding issues related to the appropriateness of Inpatient DRG assignments.
Work collaboratively with the CDI Staff to facilitate documentation within the medical record that supports patients severity of illness and risk of mortality utilizing strong communication skills with physicians, case managers, utilization reviewer, nurse or other healthcare professionals, utilizing appropriate querying tools to capture needed documentation.
Manage individual(s) including, but not limited to, interviews, trainings, assigns work, manages and evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.
Complete initial review of inpatient health records within 24-48 hours of admission and outpatient health records for a specified patient population to evaluate documentation to assign the principal diagnosis and pertinent secondary diagnoses for severity of illness and risk of mortality
Query physicians regarding missing, under, or conflicting health record documentation and obtains additional documentation within the health record when needed
Complete initial review of outpatient health records within 24 to 48 hours for a specified population to evaluate documentation to assign the principle diagnosis and pertinent secondary diagnosis for severity of illness and risk of mortality to meet the CMS two midnight rule.
Demonstrate a thorough understanding of the Medicare Severity (MS)-DRG system, CCs/MCCs, impact on quality, and CMI as well as ICD-10-CM/PCS coding systems and the guidelines related to Clinical Documentation Improvement.
Maintain CDI Dashboard and reports monthly analysis to the CDI Staff.
Attend clients monthly Utilization Review Committee Meetings and coordinate any assignments related Clinical Documentation.
Attend coding/financial educational programs and regulatory educational programs and updates as necessary to maintain expert knowledge base.
Quarterly review of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS.
Attend Coding Updates and all coding conference calls as well as required CDI education.
Prepare weekly team performance reports including weekly production, quality assessments and coding inventory reports, i.e., coding queries and submit to the manager for review.
Mentor the CDI in building effective relationships with the providers they support.
Coordinate employees schedules, including vacation/sick request to ensure adequate coverage.
Lead weekly team meetings with CDI staff.
Foster an environment of teamwork and service excellence within the department.
Educate physicians and key healthcare providers regarding clinical documentation Improvement and the need for accurate and complete documentation in the health record
Demonstrate an understanding of medical necessity, severity of Illness, complications, comorbidities, risk of mortality, case mix, secondary diagnoses, and procedures, and is able to impart this knowledge to physicians and other members of the interdisciplinary healthcare team
Collaborate with the physician advisor, case managers, nursing staff, and other ancillary staff regarding interaction with physicians on documentation and to resolve physician queries prior to patient discharge
Participate in the analysis, interpretation and trending of statistical data for specified patient populations to identify opportunities for clinical documentation and process Improvement
Assist with preparation and presentation of clinical documentation monitoring and trending reports for review with physicians and hospital leadership
Educate members of the patient care team regarding specific documentation needs and reporting and reimbursement issues Identified through daily and retrospective documentation reviews and aggregate data analysis
Facilitate change processes required to capture needed documentation, such as forms and screen design
Partner with the coding professionals to ensure adequate coding understanding to support clinical documentation necessary to determine a working severity of illness
Review and clarify clinical issues In the health record With the coding professionals that would support accurate and specific diagnoses and procedural coding
Assist in appeal process resulting from third-party reviews
Meet with the HIMS Coding Staff on a regular basis to participate in post-discharge coding reviews to ensure the most accurate DRG has been assigned and to identify opportunities for clinical documentation improvement for future cases.
Perform other duties as assigned
Minimum Qualifications:
Bachelors degree from an accredited college of university
Registered Health Information Technician (RHIT)

OR

a Registered Health Information Administrator (RHIA)
Four (4) years of experience as a registered health information technician, or as a registered health information administrator

OR

a combination of the three totaling three (3) years of experience
Two (2) year of experience within the last five (5) years working in Clinical Documentation Improvement
Two (2) years of experience supervising and/or managing staff
Two (2) year of experience working with Case Mix, ICD 10 coding, principal and secondary diagnoses, procedures, complications, comorbidities, severity and patient mortality risk
Current experience with federal, state, and other payers regulatory requirements and criteria including, but not limited to, Medicare and Medicaid
Prior experience working in a hospital or health care environment
Certified Documentation Improvement Practitioner (CDIP), or Certified Clinical Documentation Specialist (CCDS)
Must be detail oriented for clinical documentation review
Must be familiar with electronic health record systems, i.e., Cerner or Siemens
Preferred Qualifications & Certifications:
Licensed as a Registered Professional Nurse in the State of Illinois
Five (5) years of acute care nursing experience or as a registered health information administrator
Two (2) years of experience within in the last three (3) years working in Clinical Documentation Improvement
Two (2) years of experience working with Case Mix, ICD 10 coding, principal and secondary diagnoses, procedures, complications, comorbidities, severity and patient mortality risk
Two (2) years of experience with federal, state, and other payers regulatory requirements and criteria including, but not limited to, Medicare and Medicaid
Current experience with InterQual and/or Milliman Care guidelines
Certified Coding Specialist (CCS), Certified Coding Specialist Physician-based (CCSP), or Certified Professional Coder (CPC)
Registered Health Information Administrator (RHIA)

Knowledge, Skills, Abilities and Other Characteristics:

Ability to develop and maintain supportive, collaborative relationships with Physicians and other clinical professional
Ability to provide concise reports of activities and results.
Ability to work independently in performing duties with minimal supervision with a high degree of self-motivation
Ability to teach in a large group setting to educate healthcare providers about current documentation standards
Ability to track activities and communication across multiple physician services and forums
Ability to work with clinical manager, case management, and physicians to make clinical documentation improvements, i.e. change clinical documentation processes
Ability to analyze problems and issues and understand the regulatory and reimbursement impact of those decisions
Ability to become adaptable and self-motivated by staying abreast of CMS rules and regulations and incorporating those changes into daily practice
Proficiency in Microsoft Office Suite (Word, Excel, and PowerPoint)
Compensation Package:
Competitive Salary
Paid Time Off
Health, Vision & Dental Insurance
Health Savings Account (HSA)
Flexible Spending Account (FSA)
Short & Long Term Disability
401 (K) with company match
Life Insurance
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