This position reports to the CDI Compliance and Data Manager and is responsible for identifying performance improvement opportunities related to Clinical Documentation Integrity for the CDI team, the providers, and other departments contributing to the interdisciplinary care team of each patient. Through analysis of a variety of data sets, dashboards and audits, this position assists in identifying gaps, root causes and solutions for CDSs across the SCL system and physician leadership. Conducts chart audits, denial mitigation, coding collaboration, reconciliation, query validation, and education, are also performed, as appropriate.
Responsible for regular audits of the CDS chart reviews to identify educational and improvement opportunities (i.e. gaps in clinical indicators and diagnostic statements which impact DRG assignment, severity of illness, risk of mortality and resource utilization) for further development and growth.
Perform quantitative and qualitative review and analysis of health records and physician queries, both concurrently and retrospectively, to ensure documentation is accurate, consistent, complete and assigned codes can be supported by documentation.
Conduct chart reviews based on DRGs and Care Site-specific trends to identify gaps in documentation and training opportunities.
Provide audit findings to the CDI Leadership team to assist with development of an action plan when improved opportunities are identified.
Provide review on clinical validation denial cases provided by Coding team.
Perform 2nd level review on cases identified through the CDI reconciliation and query validation processes.
Conduct 2nd level reviews requested by Coding team through the DRG mismatch process.
In collaboration with CDI Managers, develop, coordinate and complete internal monitoring and auditing activities to ensure compliance with documentation, coding and billing practices.
In collaboration with the CDI Managers, analyze provider performance measures and assist in identification of provider specific education needs related to CDI process and clinical documentation.
In collaboration with the CDI Managers, aid in the collection and reporting of the CDI program metrics as needed.
Collaborate with CDI Educator(s) on the development of CDS education materials and physician education materials to ensure consistency in education.
Promote the mission, vision, and values of SCL Health, and abide by service behavior standards.
Perform other duties as assigned.
Bachelor’s Degree in Nursing, Health Information Management, or related field.
CDIP or CCDS certification.
Previous clinical documentation audit experience.
Minimum of 3 to 5 years previous CDS experience.
Experience in a clinical setting.
Clinical experience in an acute care hospital preferred.
Knowledge of CMS Medicare Part A, B, and C, Medicaid Managed Care and Commercial health plan billing, reimbursement and regulations.
Knowledge of quality measures, patient safety indicators.
Understand how ICD codes, DRGs and SOI/ROM scores are used for reimbursement, public reporting or outcomes, reviewing quality of patient care, financial modeling, strategic planning and marketing.
Experience with Epic, 3M CDIS, Microsoft Suite (Excel, Word, PowerPoint, Publisher, Outlook, Access).
Knowledge of ICD-10-CM and PCS coding indices, guidelines, Coding Clinics, and other references.
SCL Health is a faith-based, nonprofit healthcare organization that operates eight hospitals, four safety net clinics, one children’s mental health center and more than 190 ambulatory service centers in three states – Colorado, Kansas and Montana. The health system includes 15,000 full-time associates and more than 500 employed providers.