JOB SUMMARY

Conducts post discharge data quality validation audits of inpatient cases. Validates the documentation supports the final MS-DRG assignment and is in compliance with the official coding guidelines as supported by clinical documentation in health record. Identifies potential documentation improvement opportunities and MS-DRG opportunities, researches appropriate guidelines to support recommended changes and communicates the changes to coding in a timely manner. Provides documentation education and expert CDI advice to the Coding and CDI staff. Development of educational programs which provide CDI education for the new CDI employees and ongoing education for all CDI staff. Develops education materials for staff to support members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management. Create reports used to make strategic decisions. Educates and trains CDI staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Validation: CDI Chart review, validation, and auditing: Reviews the medical records to validate complete and accurate documentation, which supports the code and MS-DRG assignments, identifies any potential diagnoses and procedures that may have been missed, proposing physician queries (if needed), and validates concurrent and/or retrospective queries for compliance. Follows industry coding and documentation guidelines (e.g., Official ICD coding guidelines, Coding Clinic advice, Ascension Health coding policies and procedures, and AHIMA/ACDIS Query guidelines) so as to maintain system-wide coding consistency and to remain in compliance with governmental and other regulatory guidelines.
• Data Quality: Reviews medical record documentation for quality, to include, Severity of Illness and Risk of Mortality cases. Demonstrated ability to achieve accuracy and consistency in the selection of principal and secondary diagnosis (including MCC & CC) and procedures. Use of industry standard reports (PEPPER) and client specific entities (MARSI) as a tool /guide for identifying assessment opportunities.
• Education: Communicates effectively the audit findings (to include opportunities) with CDI and coding teams, maintaining positive relationships so as to effectively and efficiently address and resolve CDI issues.
• Educator: Develops comprehensive CDI Orientation plan for all new CDI staff. Conducts on going staff education and develops the education program materials including online materials, handouts, Power Point Presentations, etc.
• Professional Development: Stays current with licensure requirements as well as AHA Official Coding and Reporting Guidelines, CMS and other agency directives for Clinical Documentation Improvement programs. Attends any educations related to documentation and coding guidelines.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Knowledge of medical terminology
• Knowledge of anatomy, physiology, and pathophysiology and drugs appropriate for treating specific disease processes
• Expert knowledge of clinical documentation improvement processes, procedures and opportunities and skilled in critical thinking
• Knowledge of IPPS reimbursement methodology
• Expert knowledge of official coding guidelines, Coding Clinic advice and CMS, OIG, RAC/QIO regulations and reimbursement guidelines as they apply to MS-DRG assignment
• Knowledge of ICD-9-CM and CPT-4 codes; including ICD-10 training
• Knowledge of coding and MS-DRG grouping software and database basics
• Knowledge of Microsoft Office software products (Excel, Word, PowerPoint)
• Knowledge of computers, including hardware, software, and applications
• Knowledge of the English language (including structure, content, spelling, rules of composition, and grammar) Excellent written and verbal communication skills
• Must be detail oriented and have the ability to work independently
• Must display excellent interpersonal skills
• Must demonstrate initiative and discipline in time management and assignment completion
• Excellent organizational skills for initiation and maintenance of efficient work flow
• Must be able to work in a virtual setting under minimal supervision

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

• Associate or Bachelor degree in Nursing or Health Information Management, or Health Informatics.
• Minimum of three years CDI experience. Prefer 1-2 years of management, and/or teaching/ training experience.

CERTIFICATES, LICENSES, REGISTRATIONS

• Must have at least two of the following:
• Current Registered Nurse (RN) or LPN license
• CDI Credential (CCDS or CDIP)
• AHIMA Credentials (RHIA,RHIT)

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Duties may require bending, twisting and lifting of materials up to 25 lbs.
• Duties may require driving an automobile to off-site locations.
• Duties may require travel via, plane, care, train, bus, and taxi-cab.
• Ability to sit for extended periods of time.
• Must be able to efficiently use computer keyboard and mouse to perform coding assignments.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Floats between clients as requested.
• Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.

OTHER

• Occasional travel may be required

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $81,952.00-$122,907.00 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.