Clinical Documentation Integrity Manager - PARTNERS HEALTHCARE SYSTEMS INC

Job Summary

The Clinical Documentation Integrity Manager (CDIM) is responsible for the day-to-day management of the CDI team. The Manager provides support to CDI specialists (CDIs) in coordinating all CDI operational processes and works to achieve and maintain CDI and Compliance departmental goals.

Under the direction of the Spaulding chief Compliance Officer, facilitates improvement in the overall quality, completeness and accuracy of medical record documentation for the purposes of ensuring compliance with Medicare, Medicaid (CMS) regulations and guidelines and to expedite appropriate reimbursement.Assists with IRF CMS 60% management, concurrent DRG/CMG/PDPM assignment, diagnosis documentation gaps and ongoing documentation integrity and clinical staff new hire orientation.

• Partners with CDI Medical Director to educate physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the medical record.
• Manages day-to-day CDI operations
• In collaboration with the Spaulding Coding Manager, assures compliance with Official Coding Guidelines, Regulatory Compliance Guidelines and CDI policies
• Plan, direct, organize and manage the CDI team to meet key performance indicators (CMI, LOS, PI, others as applicable)
• Coordinate meetings and education for the CDI Team on IRF, LTCH, SNF documentation requirements, EHR updates and notifies the team of coding/billing updates as needed with Coding Manager
• Represents the CDI Team at meetings and committees
• Coach, facilitate, problem solve CDI workflows
• Assist in hiring, onboarding, orientation and training of new team members
• Complete ongoing and annual performance evaluations of CDI team members
• Assists Compliance Officer in the review and improvement of documentation and CDI processes and services
• Assists with Preparation of CDI reports including key CDI program metrics to senior management
• Approve PTO requests, assuring adequate staff coverage utilizing FT, PT, per diem resources
• Aids the CDI team (IRF, LTCH, SNF) with valid clinical reviews and compliant physician queries
• Maintains and develops Compliant Physician Query Templates located in the Electronic Health Record.
• Assists Corporate Compliance Officer with developing CDI metrics and report system for IRF and LTCH (supports SNF MDS staff who act as CDIs for SNF level of care, includes financial impacts and query trends
• Assists the Senior Financial Analyst or other colleague, in developing, maintaining, and updating CDI Metrics databases (or other collection tools) for IRF and LTCH
• Assists CDI team with daily inpatient reviews within 24- 72 hours of admission (by day four for Functional Measures review) and throughout hospitalization to:

a) evaluate documentation that supports the coder’s assignment of the reason for admission and/or etiologic diagnosis, principal diagnosis, and comorbidities and complications that support the CMG/DRG/PDPM. This does not include a review of the impairment group code assignment for the IRF.

b) document, review details in Epic for physician notification and response

• Assists CDI team to conduct concurrent follow up reviews of patients to support and assign additional diagnoses that may impact length of stay. Queries physicians regarding missing, unclear or conflicting medical record documentation by requesting and obtaining additional documentation within the medical record as applicable
• Collaborates with CDI Medical Director, Chief Compliance Officer, case managers, nursing staff and other ancillary staff as applicable to resolve physician queries prior to patient discharge.
• Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement.
• Assists the Outcomes Manager/applicable staff with trending, tracking, and educating the Interdisciplinary Team based on external (i.e., PEPPER) and internal data to improve outcomes.
• Applies diplomacy and professionalism when interacting with physicians and clinical staff; especially when addressing missing or conflicting medical record information
• Acts as a consultant to providers, management, administration and billing staff regarding documentation, coding, and reimbursement and compliance matters.
• Assists CDI team or directly provides orientation for new clinical staff regarding documentation requirements and coding/billing
• Assists in coordinating responses to third party payer audits and/or requests when appropriate
• Keeps current with reimbursement and coding changes, proposed and otherwise, through conferences, reference material and review of current literature
• Maintains confidentiality of all customer/hospital information.
• Demonstrates flexibility in the face of changing work environment, adjusting work schedule accordingly.
• Upholds the Spaulding Organizational Values of Innovation, Collaboration, Accountability, Respect, and Excellence
• Perform other duties as assigned

• Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients
• Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships
• Delivers information in a clear, concise and compelling manner
• Delivers targeted and actionable communications that invites two-way professional communication; adjust messages appropriately by audience
• Demonstrates a willingness and ability to assist others

Self-Development

• Demonstrates proficiency in current and emerging technologies (Epic, Microsoft Office)
• Simultaneously uses multiple technologies
• Independently takes proactive steps toward problem resolution
• Completes all mandatory and assigned education by established deadlines
• Attends scheduled meetings and continuing education programs

Qualifications and Experience

• Graduate of an accredited School of Nursing.
• 1+ year of CDI experience required
• Current licensure from the Massachusetts Board of Registration to practice professional nursing
• Certificate in Case Management or Clinical Documentation Improvement (CDIP) preferred
• Minimum of 5 years experience in either clinical nursing, case management, HIM inpatient coding or an equivalent combination of these disciplines
• Knowledge of post-acute regulatory/accreditation requirements preferred
• Basic knowledge of coding/classification systems appropriate for inpatient CMG and DRG prospective payment system
• Computer proficiency required; Microsoft office applications preferred with ability to learn new software.
• High level of service delivery. Demonstrate initiative with ability to prioritize work, meet deadlines and adapt to changing situations.
• Work independently, be self-directed and contribute as a leading member of a team.
• Ability to clearly present information in writing and in presentation form.
• Maintain variable work schedule to meet department needs. (evenings, holidays, weekends and limited travel).

SRN is committed to diversity in the workplace which begins with respect and opportunity for all. SRN takes affirmative action to ensure that equal employment opportunity is provided to all persons regardless of race, religious creed, color, national origin, sex, sexual orientation, gender identity, genetic information, age, ancestry, veteran status, disability or any other basis that would be inconsistent with any applicable ordinance or law. If you need a reasonable accommodation in coming to or participating in the interviewprocess, please let us know.