CDI Quality and Performance Improvement Analyst-17005724
The CDI Quality and Performance Improvement Analyst position is eligible for up to $2,500 in relocation assistance and up to $5,000 sign-on bonus.
This position reports to the CDI Compliance andData Manager and is responsible for identifying performance improvementopportunities related to Clinical Documentation Integrity for the CDI team, theproviders, and other departments contributing to the interdisciplinary careteam of each patient. Through analysisof a variety of data sets, dashboards and audits, this position assists inidentifying gaps, root causes and solutions for CDSs across the SCL system andphysician leadership. Conducts chartaudits, denial mitigation, coding collaboration, reconciliation, queryvalidation, and education, are also performed, as appropriate.
Responsible for regular audits of the CDS chartreviews to identify educational and improvement opportunities (i.e. gaps inclinical indicators and diagnostic statements which impact DRG assignment,severity of illness, risk of mortality and resource utilization) for furtherdevelopment and growth.
Perform quantitative and qualitative review andanalysis of health records and physician queries, both concurrently andretrospectively, to ensure documentation is accurate, consistent, complete andassigned codes can be supported by documentation.
Conduct chart reviews based on DRGs and Care Site-specifictrends to identify gaps in documentation and training opportunities.
Provide audit findings to the CDI Leadership team toassist with development of an action plan when improved opportunities areidentified.
Provide review on clinical validation denial casesprovided by Coding team.
Perform 2nd level review on casesidentified through the CDI reconciliation and query validation processes.
Conduct 2nd level reviews requested byCoding team through the DRG mismatch process.
In collaboration with CDI Managers, develop,coordinate and complete internal monitoring and auditing activities to ensurecompliance with documentation, coding and billing practices.
In collaboration with the CDI Managers, analyzeprovider performance measures and assist in identification of provider specificeducation needs related to CDI process and clinical documentation.
In collaboration with the CDI Managers, aid in thecollection and reporting of the CDI program metrics as needed.
Collaborate with CDI Educator(s) on the developmentof CDS education materials and physician education materials to ensureconsistency in education.
Promote the mission, vision, and values of SCLHealth, and abide by service behavior standards.
Perform other duties asassigned.
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.
We reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.
Inspired by our faith,
•We will be distinguished as the premier person-centered health system and trusted partner.
•We will share accountability with clinicians and other stakeholders to coordinate care across all settin...gs and improve access, quality, health outcomes, and affordability.
•We will grow as community-based health networks to serve more people in partnerships with others who share our vision and values.
Caring Spirit - We honor the sacred dignity of each person.
Excellence - We set and surpass high standards.
Good Humor - We create joyful and welcoming environments.
Integrity - We do the right thing with openness and pride.
Safety - We deliver care that seeks to eliminate all harm for patients and associates.
Stewardship - We are accountable for the resources entrusted to us.