Manager Clinical Documentation Integrity - Fairview Health Services

Job Summary:

This position is responsible for managing and coordinating the day-to-day activities of the Clinical Documentation Integrity (CDI) department and personnel. The CDI program facilitates and promotes standardization of documentation across the system and ensures high-quality documentation is present within the record and supports a compliant and accurate representation of the clinical care provided to the patients served. Is responsible for creating and coordinating internal education and programming, training, productivity, work assignments, quality reviews, and reports for the CDI program. Acts as a liaison for hospital operations, revenue cycle leadership, information technology, medical staff, residents, utilization review, quality, risk, service lines, and other departments across the system.

Assures maximum inpatient designated cases are reviewed and working diagnosis related groups (DRGs) are assigned concurrently and at the appropriate intervals throughout the patient’s stay. Works directly with coding to ensure quality, education and record reconciliation occurs as appropriate to ensure documentation compliance with regulatory requirements.

Job Expectations:

•  Oversees clinical documentation integrity program to ensure daily CDI operations meets and/or exceeds departmental objectives, goals, and benchmarks
•  Manages and acts as a resource to the personnel assigned as direct reports and assures appropriate prioritization of reviews and re-reviews are performed daily.
•  Develops clinical data reporting and uses analytical assessment of data, data manipulation, and professionally articulate data outcomes to improve work quality, query activity and documentation outcomes.
•  Establishes and monitors employee workflows, productivity, and quality standards. Evaluates staff performance
•  Helps create, pursue, prioritize, and activate strategies and tactics to identify documentation opportunities using internal DRG pairs and triplets to national data sources to achieve improved documentation outcomes as appropriate
•  Leverages national data and remains current with payer trends needed to educate and lead teams to achieve benchmark performance.
•  Develop and monitor internal key performance indicators and facilitates appropriate clinical documentation reviews to support accurate assignment of diagnosis codes, procedure codes, present on admission (POA) indicators, patient safety indicators (PSI),hospital acquired conditions (HAC), severity of illness (SOI), risk of mortality (ROM), CC/MCC capture.
•  Working in partnership with leadership to develop standard queries and policies and procedures for system-wide CDI practices to meet internal and external requirements including payer, regulatory, accreditation, and industry best practices.
•  Acts in a leadership capacity to help drive CDI initiatives including building a physician advisor program, provider education, and technology advancements.
•  Support revenue cycle governance and taskforce team projects that focus on continuous process improvement initiatives to achieve goals and objectives.
•  Identifies and helps activate automation opportunities within applications and electronic medical record to optimize workflow and documentation outcomes as appropriate
• Acts as a resource and helps to validate post claim DRG downgrade denials related to coding and clinical determination to support appeal strategy, tracking by disease, payer and denial activity and works with teams to create transparency and improvements to mitigate and prevent denials.
• Oversees professional competency and training of all staff and CDI functions system wide.
• Responsible for coordinating DRG reconciliation processes between CDI and coding teams.
•  Works collaboratively with vendors to assure performance expectations are being met.
•  Creates strong partnerships with internal and external departments and customers in addition to influencing improved clinical documentation capture.
•  Interviews, selects, hires, and performance manages staff.
•  Identifies and actively participates in deploying new technology, system optimization, and workflow automation.

Required Qualifications

•  Bachelor's degree in Health Information Management, Nursing, Education or related field or equivalent combination of Associate degree in Health Information Management, Nursing, Education, or related field and 6 additional years of minimum work experience.
• Experience
• 3 years of supervisory and/or management experience.
•  At least 3 years of inpatient coding or clinical documentation integrity (CDI) experience.

License/Certification/Registration

• One of the following: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Coding Specialist-Professional (CCS-P) Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Registered Nurse (RN), Certified Documentation Integrity Specialist (CCDS), or Certified Documentation Integrity Practitioner (CDIP).

Preferred Qualifications

•  Master’s degree in Health Information Management, Nursing, Education, or related field

•  More than 3 years of supervisory and/or management experience.
•  5 years of coding or clinical documentation integrity (CDI) experience.

License/Certification/Registration

•  One of the following: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Coding Specialist-Professional (CCS-P) Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA).

AND

•  One of the following: Registered Nurse (RN), Certified Documentation Integrity Specialist (CCDS), or Certified Documentation Integrity Practitioner (CDIP).