Manager, Clinical Documentation Integrity

Clinical Documentation Integrity Manager

The Clinical Documentation Integrity Manager oversees the daily operations of the Carle Health CDI program which is inclusive of staff activities, data collection, analysis and reports in order to meet organizational goals. In conjunction with the HIM Director the CDI Manager ensures the quality, accuracy and timeliness of the CDI process and outcomes. This position is responsible for monitoring and optimizing case mix index, mortality and severity of illness metrics for Carle facilities and any required reporting for these metrics as well as monitoring compliance with regulatory requirements. The CDI manager assures consistent workflow with concurrent review of inpatient hospital encounters by hiring, training and maintaining sufficient staffing to meet program objectives.

The CDI Manager partners with the HIM physician advisors and medical staff leaders to identify education needs and develop education for providers related to clinical documentation integrity and the DRG system. Additionally, this position works in tandem with the hospital Coding Manager to assure DRG coding is accurate, coding queries are managed, and education is provided to the coding team related to CDI. The CDI Manager also partners with other Revenue Cycle leaders to trend and respond to inpatient denials as appropriate.

Qualifications

Certifications:

• Registered Health Information Administrator (RHIA) or
• Certified Coding Specialist (CCS) or
• Licensed Registered Professional Nurse (RN) within 6 months - if licensed in another state

Education:

• Bachelor's Degree: Nursing or
• Bachelor's Degree: Health Information Administration

Work Experience:

• Healthcare Team Management - 3 years
• Inpatient Coding and/or Clinical Documentation - 3 years
• ICU or Cardiac Surgery or Neurosurgery - 2 years
• CDI (preferred)

Additional Skills and Knowledge:

• Well versed in Microsoft Office tools (Excel)
• Well versed in Epic
• Up to date on all coding guidelines
• Familiar with Medicare coding guidelines and rules
• Excellent communication skills both verbal and written

Responsibilities:

• Manage the CDI team including but not limited to:
  • hiring, training, managing and evaluating team performance
  • conducting professional development plans.
• Ensure productivity and accuracy standards are met
• Support overall department and Carle organizational goals.
• Assist Director in budgeting for the CDI department.
• Collect, analyze, present data, and solutions related to CDI team performance, provider performance, query outcomes and documentation issues across Carle.
• Develop and execute CDI process improvement projects.
• Collaborate extensively with HIM physician advisors, Carle medical staff, vendors and coding leadership
• Provide data and solutions to further Carle's objectives related to the CDI program.
• Oversees the development and implementation of ongoing formal and information education of the medical staff, coders, CDI, and other staff as needed related to CDI topics.
• Reviews and develops policies and procedures to support compliant CDI workflows.
• Develops reports as needed and communicates CDI metrics to internal and external teams as needed.
• Works with software vendor and external consulting groups
• Ensure software efficacy
• Ensure integrity of the data from these teams and software applications
• Ensure vendor is compliant with contractual obligations.
• Participates in and leads multidisciplinary teams
• develop and implement best practices in Clinical Documentation Improvement.
• Provides feedback to Director of Coding and CDI on exceptional and substandard CDI performance as needed.
• Provides support and guidance in all Carle Experience and Carle Behavior Standards initiatives.
• Presents CDI metrics as requested or required at department and external meetings.
• In conjunction with the coding managers evaluates ongoing requirements for coding and DRG assignment yearly.
• Provides support of and guidance in all Carle Experience and Carle Behavior Standards and Initiatives.