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Clinical Documentation Integrity (CDI) Specialist- Remote

at Guidehouse in Topeka, Kansas, United States

Job Description

Overview

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.

Responsibilities

The Remote Clinical Documentation Integrity (CDI) Specialist is responsible for conducting concurrent inpatient chart reviews on assigned units to ensure documentation is complete and accurate at the time of discharge to properly reflect the severity of illness and resources consumed for timely, accurate and compliant coding. Initiates queries in a professional, non-leading manner to clarify ambiguous or conflicting documentation, obtain specificity of diagnoses, and connect treatment performed to a diagnosis (if known). Performs coding, working DRG assignment and enters all review activity into tracking software. Perform any and all related job duties as assigned. This position is 100% Remote.

+ Conducts daily, concurrent review of inpatient records on assigned unit(s), to ensure complete and accurate physician and or clinician documentation is present at the time of discharge for accurate, timely, and compliant coding.

+ Reviews daily admissions to assigned unit, performs initial code assignment for a working DRG and completes CDI software data entry for initial and follow up case reviews (or worksheet to include code and DRG assignment) and submits to Program Assistant

+ Updates “working DRG” as documentation supports or physician query answer supports a change in the DRG assignment.

+ Communicates to the CDI Coordinator when volume of daily review assignments is too high or low so that CDI Coordinator can assist in adjusting review assignments amongst the team.

+ Initiates compliant physician queries when documentation is confusing, ambiguous or missing and follows up with MD to seek immediate response to query (utilizing the following AHIMA practice briefs as a guide: “Managing an Effective Query Process”, October 2008 and “Guidance for Clinical Documentation Improvement Programs”, May 2010).

+ Ensures the query verbiage is in no way leading or suggestive in tone and is supported by the documentation in the record to include clinical indications and treatment provided.

+ Performs follow up on incomplete physician queries to obtain an answer while the patient is stlll in house.

+ Analyzes complete clinical documentation from a compliance, coding and/or reimbursement perspective including rationale for the initiation, discontinuation and/or adjustment of treatment modalities utilized in the care of the patient.

+ Assures physician has sufficient documentation for corresponding diagnosis of all monitored, evaluated or treated illnesses and initiates queries as appropriate.

+ Identifies possible documentation risk areas, including missing orders, patient identification, legibility issues and poor documentation trends.

+ Provides daily feedback and education to physicians on the quality of documentation and presents examples of how physician documentation can improve compliance based on CMS guidelines.

+ Promotes accurate DRG classification according to standards set forth by CMS (Center for Medicare & Medicaid Services) to reduce documentation-related-risks associated with DRG-based payers.

+ Assures record reflects the patient’s severity of illness and risk of mortality (ROM) to improve accuracy of hospital case mix index, national comparisons and physician profiles.

+ Possesses a clear understanding of MS DRG guidelines and required documentation components for accurate code/DRG assignment.

+ Keeps abreast of Coding Clinic updates, to include code changes, MCC and CC changes and/or changes in the DRG system to effectively educate DI team and physician and clinical team members regarding changes.

+ Keeps abreast of Recovery Audit Contractor (RAC) review activity to avoid potential risk for the facility.

+ Assists in developing reports as needed for the review and analysis of facility specific documentation and reimbursement patterns

+ Assists in development of physician and/or clinician education

+ Provides accurate and up-to-date information on regulatory and reimbursement requirements

+ Works closely with case management, physicians, clinicians, and departments to improve communication regarding documentation and reimbursement issues

+ Investigates and responds timely to questions regarding documentation or coding issues.

+ Educates physicians, clinicians, and departments on documentation, coding, and reimbursement guidelines and facilitates understanding of payer and regulatory requirements

+ Attends scheduled physician education/training sessions on clinical units and/or MD offices as requested on a daily and/or weekly basis.

+ Builds trustworthy and strong relationship with client staff, physician base and Guidehouse staff.

+ Stays current on documentation & billing requirements to ensure compliance with all regulatory and governmental agencies

+ Observes confidentiality and safeguards all patient-related information.

+ Serves as a role model for all co-workers by setting an example of high standards in dress, conduct, cooperation and job performance

+ Meets or exceeds established quality and productivity standards.

+ Checks e-mail system at a minimum of three times per day: beginning, middle, and end of working day.

+ Assists with coding backlogs and performs other duties as assigned.

Qualifications

Education:

+ Graduation from accredited School of Nursing; BSN or Bachelor’s degree in health related field and/or Masters required OR

+ Graduation from accredited medical school; MD or DO required, or RHIA/RHIT with CCS Certification

Experience:

+ Minimum of two (2) years as a Clinical Documentation Integrity Specialist preferred Exhibits strong clinical knowledge with a critical thinking skillset

+ Experienced Clinical Documentation Integrity Specialist (minimum 2 years) with a strong understanding of disease processes, clinical indications and treatments; and provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors. Displays a solid understanding of hospital acquired conditions (HAC’s), patient safety indicators (PSI’s) and mortality models.

+ Experience with encoder and DRG assignments

+ Maintains working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system

+ Excellent communication skills, with ability to listen and understand client request and needs while employing professionalism and effectiveness

+ Ability to conduct meaningful conversations and /or presentations with providers in all situations

License/Certifications/Registrations

+ Currently licensed or licensed by endorsement as a Registered Nurse, MD or MD equivalent or credentialed coder with current CCS credential.

Preferred:

+

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Job Posting: JC216788049

Posted On: Jun 22, 2022

Updated On: Aug 17, 2022