Clinical Documentation Integrity - Second Level Reviewer

Clinical Documentation Integrity (CDI) Second Level Reviewer

The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex, secondary case reviews to facilitate and obtain appropriate provider documentation for clinical conditions or procedures to reflect severity of illness, expected risk of mortality, accuracy of patient outcomes, and complexity of patient care. Serves as key resource for CDI/Coding/Quality. The CDI Second Level Reviewer works in collaboration with CDI & quality leadership, CDI specialists, coders, quality analysts, providers, and other members of the healthcare team to ensure accurate, high-quality clinical documentation to support UHealth initiatives. Adheres to departmental and organizational goals, objectives, standards of performance, policies and procedures, continually ensuring quality documentation and regulatory compliance.

Duties and responsibilities include:

• Ensuring accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes.
• Performing high-level, complex, timely secondary case reviews concurrently and retrospectively to identify potential gaps or opportunities to facilitate improved provider documentation.
• Ensuring clinical documentation accurately reflects the level of care rendered, severity of illness, risk of mortality, and clinical validation (in compliance with government and other regulations).
• Applying advanced knowledge of CMS star rating, Vizient, and US News and World Report risk-adjustment systems to identify clinical documentation improvement opportunities.
• Completing quality reviews focused on CDI quality elements, such as Mortality, Hospital Acquired Conditions (HAC), and other publicly reported patient quality or safety metrics (i.e. AHRQ Patient Safety Indicators).
• Identifying trends and key areas for improvement in querying, coding, and documentation integrity.
• Demonstrating proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG by providing information regarding clinical documentation opportunities, coding and DRG issues, as well as performance improvement methodologies.
• Recognizing opportunities for documentation improvement using strong critical-thinking skills and sound judgment in decision making, keeping integrity and compliance at the forefront of considerations in addition to outcomes, reimbursement, and regulatory requirements.
• Facilitating high-quality documentation by utilizing queries that are effective, clear, concise, and compliant in accordance with latest AHIMA/ACDIS Query Practice Brief.
• Making recommendation of possible refinement of principal diagnosis, secondary diagnoses, and/or procedures based on clinical data to facilitate appropriate DRG assignment.
• Recording review findings and other data elements accurately into CDI Software and other data mechanisms to support data integrity for reporting.
• Effectively and appropriately communicating and collaborating with providers, HIM/coding, quality, CDI, and other members of the healthcare team.
• Assisting with concurrent and retrospective CDI case reviews, quality audits, and education as deemed necessary by CDI Leadership.
• Working independently; demonstrating effective time management and prioritization of tasks.
• Participating in meetings, including providing feedback and identifying trends and opportunities, presentations for educational opportunities, and any other needs identified by the CDI leaders.
• Assuming responsibility for professional development through participation at workshops, conferences, and/or in-services and maintaining appropriate records of participation.
• Participating in departmental and organization projects, task forces, and/or committees as needed.
• Complying with and ensuring adherence to HIPAA and Code of Conduct policies.

Education: Four (4) Year/bachelor's degree required; BSN/BS/BA in related field Required; Graduate degree in Healthcare Administration, Informatics, Nursing, Leadership, Education or related field preferred.

Certification and Licensing: Current RN or MD required; CCDS or CDIP certification required; Coding certification (CCS, CIC, or CPC) preferred.

Experience: At least three (3) years recent inpatient clinical documentation improvement (CDI) experience required. Demonstrated extensive clinical knowledge, critical-thinking skills, and understanding of disease processes, pathophysiology, and disease management/treatment required. At least three (3) years of direct patient care clinical experience in hospital setting preferred. Proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG required. At least one (1) year experience with mortality, PSI, HAC, or other quality-focused reviews required. Knowledge of Vizient, Premier, US News and World Report, CMS star rating or similar risk-adjustment methodologies highly preferred. Prior experience in an academic medical center (AMC) or large health system preferred. Proficiency with Microsoft Office (Excel, PowerPoint, Word, Outlook) required. Proficiency with CDI software and encoder required. Experience with 3M 360 Encompass preferred. Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.