HIM CDI Ambassador

Job Summary

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The CDI Ambassador will develop and maintain physician and medical staff relationships while acting as a liaison between the CDI Specialists, HIM, and the hospital’s medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity of illness, acuity and risk of mortality and appropriate DRG assignment for optimal reimbursement. The Ambassador will provide education and assistance to physicians and medical staff regarding documentation compliance questions, CDI physician queries, and clinical preciseness that truly reflects the patient’s care and treatment course. Responsible for reviewing patient medical records to facilitate modifications to clinical documentation through concurrent (pre-bill) interaction with providers and other members of the healthcare team to promote accurate capture of clinical treatment (later translated into coded data) and to support the level of service rendered to relevant patient populations. Exhibits expert knowledge of clinical documentation requirements, MS-DRG Assignment, case mix index (CMI) analysis, clinical disease classifications, major and non-major complications and comorbidities (MCCs or CCs), and quality-driven patient outcome indicators. Interacts as needed with internal customers to include but not limited to hospital staff, physicians, residents, and other revenue cycle team members. Actively participates in department and hospital performance initiatives when needed to ensure ULH success.

Responsibilities Finalize unanswered open queries between CDI specialists and physicians. Completes initial medical record reviews of all inpatient patient accounts (all payers) within 24-48 hours of admission for a specified patient population to: Evaluate and review inpatient medical records daily, concurrent with patient stay, to identify opportunities to clarify missing or incomplete documentation. Assign the principal diagnosis, pertinent secondary diagnoses, procedures for accurate MS-DRG assignment, score risk of mortality and severity of illness and initiate a review worksheet. Conduct follow-up reviews of patients every 2-3 days to support and assign a working or final MS-DRG assignment upon patient discharge, as necessary. Spend a minimum of 50 % of the workday in the hospital as a physician resource, developing physician and medical staff relationships. Provide ongoing physician and medical staff education regarding documentation, queries, coding guidelines, clinical terminology and coding updates to improve their understanding of severity, acuity, risk of mortality, and DRG assignment. Collaborate with the Quality department and physicians to identify and resolve documentation patterns and discrepancies. Provide new medical staff orientation regarding clinical documentation and physician documentation responsibilities. Provide and develop in coordination with the CDI manager current documentation tip sheets to enhance accurate and complete documentation and coding. Recommends changes to documentation templates and physician queries based on coding changes, regulatory modifications, and quality review findings. Coordinates training and education for Coding Specialists and CDI staff when trends are identified. Provide on-call service for physician and medical staff query questions and education. Refer potential and identified HAC’s (hospital acquired conditions), PSI’s (Patient, Safety Indicators) and preventable hospital HARM’s to the Quality department. Maintain CDI department database and spreadsheets on medical staff education regarding documentation, queries, coding guidelines, medical terminology and coding updates. Formulate clinically, compliant and credible physician queries regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the health record, as necessary. Proactively collaborate with physicians to discuss and clarify documentation inconsistencies to ensure accuracy of the medical record and appropriate capture of the course of treatment provided to the patient. Educate providers about identification of disease processes that reflect SOI, complexity, and acuity to facilitate accurate application of code sets. Gather and analyze information pertinent to documentation findings and outcomes and use this information to develop action plans for process improvements. Collaborate with case managers, nursing, and other ancillary staff regarding interaction with physicians concerning documentation opportunities and to resolve physician queries prior to discharge. CDIS communicates/completes Clinical Documentation Improvement (CDI) activities and coding issues (lacking documentation, physician queries, etc.) for appropriate follow-up and resolution with appropriate leadership. Remain abreast and current on training of new hires and ongoing CDIS professional staff development as well as participate in CDI-related continuing education activities to maintain certifications and licensures. Collaborate with HIM/coding professionals to review and resolve DRG mismatches for individual problematic cases and ensure accuracy of final coded data in conjunction with CDI managers, coding managers, and/or physician advisors. Identify patterns, trends, variances, and opportunities to improve documentation review processes. Aid in identification and proper classification of complication codes and present on admission (POA) determination (patient safety indicators/hospital-acquired conditions) by acting as an intermediary between coding staff and medical staff. Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization. Qualifications

MINIMUM EDUCATION & EXPERIENCE

Bachelor’s degree in Nursing, Healthcare Administration or HIM required. 3+ years of acute care experience as a RN or 3+ years inpatient coding experience. Prior experience with 3M 360 Clinical Application and Cerner PowerChart preferred. Prior advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an inpatient setting. Active RN license (KY), RHIA or possess an active (AHIMA) CCS or (AAPC) CPC-H or CIC certified coding credential required. AHIMA CDIP or ACDIS CCDS clinical certifications required or if hired without, must obtain within 12 months of employment.

KNOWLEDGE, SKILLS, & ABILITIES

Ability to formulate clinically, compliant and credible physician queries. Working knowledge of medical terminology and Official Coding Guidelines. Ability to work independently, self-motivate, and adapt to the changing healthcare arena. Proficiency in computer use, including database and spreadsheet analysis, presentation programs, word processing, and Internet research. Working knowledge of federal, state, and private payer regulations as well as applicable organizational policies and procedures. Working knowledge of quality improvement theory and practice, core measures, safety, and other required reporting programs. Excellent verbal and written communication skills, analytical thinking, and problem solving with strong attention to detail. Proficiency in organizational skills and planning, with an ability multitask in a fast-paced environment.

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