HIM Auditor PRN - Redeemer Health

Joining Redeemer Health means becoming part of an inclusive, supportive team where your professional growth is valued. Our strength comes from bringing different perspectives and talent to our workforce, spanning PA & NJ. We offer programs that set up new team members for long-term success including education assistance, scholarships, and career training.  With medical and dental coverage, access to childcare & fitness facilities on campus, investment in your retirement, and community events, your career at Redeemer is more than a job.  You’ll discover a commitment to quality care in a safe environment and a foundation from which you can provide and receive personalized attention.  We look forward to being a part of your professional journey.  We invite you to apply today.

The Clinical Documentation Integrity (CDI) Auditor is a professional Clinical Documentation Specialist with a strong clinical knowledge base and advanced understanding of ICD-10/MS-DRG documentation requirements and coding guidelines who works under the supervision of the CDI/Coding Manager.  Responsibilities include concurrent, retrospective and secondary level clinical reviews of the medical record, resolution of DRG discrepancies, and education to the CDI team and clinical staff regarding opportunities for diagnosis clarification, principal diagnosis accuracy and improvement of capture of additional comorbid condition (CC/MCC). The CDI Auditor will conduct quality audits such as Physician Query audits, CDI Findings audit, 3M 360 Encompass workflow audits to ensure the system is being used correctly. The CDI auditor will collaborate with the Coding Compliance Auditor to assure documentation is clinically appropriate, accurately reflects code assignment and will act as a liaison between CDI and Coding to facilitate DRG mismatch resolution.  The CDI Auditor will participate in the denial review process, Focus DRGs and Quality reviews and work collaboratively with extra-departmental staff to assure documentation is clinically appropriate and accurately reflects the severity of illness and risk of mortality based on current CMS or other regulatory standards. 

The CDI Auditor will perform comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, utilize the 3M 360 Encompass system functionality and reports to conduct deep data dive analysis of diagnosis/DRG trends and patterns, collaborate with the CDI/Coding Manager, the HIM Director and the Physician Advisor to develop and provide education for the CDI and Coding team based on opportunities identified during the second level review process.  The CDI Auditor will work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and /or provider education.  Assist with the development of process improvements, and provides education based on 3M 360 Technology to achieve optimal use. 

CONNECTING TO MISSION:

All individuals, within the scope of their position, are responsible for performing their job in light of the Mission & Values of the Health System.  Regardless of position, every job contributes to the challenge of providing health care.  There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in all interactions with patients, residents, families and one another in the services we provide.

1. Minimum of 3 - 5 years’ experience as a Clinical Documentation Integrity Specialist required.
2. Experienced Clinical Documentation Integrity Specialist or CDI Second Level Reviewer with a strong understanding of disease processes, clinical indicators and treatments, and provider documentation requirements to reflect severity of illness, risk of mortality that supports the diagnosis/procedures performed for accurate clinical coding and billing based upon CMS Coding Guidelines.
3. Has a good understanding of hospital acquired conditions (HACs), and patient safety indicators (PSI’s).
4. Experience in inpatient coding, 3M 360 Encompass/encoder and DRG assignments. Ability to utilize both manual and automated versions of the ICD 10 coding classification systems is preferred.
5. Maintains working knowledge of Official Coding Guidelines, Coding Clinics and related CMS federal updates.
6. Strong critical thinking skills and ability to incorporate clinical and coding knowledge to CDI setting.  
7. Excellent communication and interpersonal relationship building skills, with ability to listen and understand colleague request and needs while employing tact and effectiveness.
8. Effective presentation/facilitation and articulation skills to achieve educational goals for
   all members of the healthcare team. Computer proficiency including Word, PowerPoint and Excel.
9. Ability to use standard desktop and Windows based computer system, including a basic understanding of email, internet, WebEx, Citrix and routine computer navigation. Ability to use other software applications (ie. 3M 360 Encompass) and electronic medical record (EMR).
10. Comfortable operating independently in a remote setting.

LICENSE AND REGULATORY REQUIREMENTS:

• Must possess at minimum Associate/Diploma Degree in Nursing, OR Health Information Technology (HIT) OR/and Advanced degree in Health Information Management, nursing or medical field such as NP/APN, PA or MD. If a nurse, must have current Registered Nurse License.
• Must possess one of the below:
  • Registered Health Information Administrator (RHIA)
  • Registered Health Information Technician (RHIT)
  • Certified Coding Specialist (CCS).
  • Licensure as a Physician Assistant (PA) or Nurse Practitioner (NP)/ Advanced Practice Nurse (APN ) or completion of medical school.
  • Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Professional (CDIP). 

Redeemer Health is an equal opportunity employer.  We prohibit discrimination in employment due to race, color, gender, religion, creed, national origin, age, sex, sexual orientation, gender identity or expression, disability veteran status or any other protected classification required by law.