Clinical Documentation Integrity (CDI) Specialist

Job Description

Job Description

Job DescriptionJob Title: CDI Specialist Department: Clinical Resource ManagementReports To: System Manager of CDI, System Senior Director of Care TransitionsJob Summary: The CDI specialist proactively collaborates with physicians, nursing, caregivers, Health Information Management, coding and billing to improve the quality and completeness of documentation of care provided. The CDI specialist will query providers as indicated to clarify gaps in documentation and support and record appropriate ICD-10 diagnosis codes in alignment with CMS and other health system regulatory agencies. Ensures accuracy and quality among medical coders, providers, nurses, billing teams, and other healthcare professionals as indicated to optimize revenue for the health system. Cayuga Health seeks an experienced RN with experience in CDI, case management, utilization review, or other systems of managed care. The CDI Specialist's goal is to balance the quality of patient care with cost efficiency, ultimately maximizing the continuity of care a patient receives while preventing and managing denials. Job Responsibilities include: Promote the mission, vision, and values of Cayuga Health System.Assesses clinical documentation to ensure documentation reflects the level of service rendered and severity of illness in compliance with governmental and payer requirements for all patientsConducts follow-up evaluation of clinical documentation to ensure issues discussed and clarified with the provider have been appropriately recorded in the patient's medical recordIdentifies potential gaps in provider documentation. Sends, follows-up, tracks and reports queries and associated responses as indicatedRecommends possible refinement of principal diagnosis based on clinical data on admission and concurrently during the hospital stay to facilitate appropriate DRG assignmentParticipates in the development and delivery of provider education to promote accurate, complete, and compliant clinical documentation in accordance with coding guidelines, regulatory requirements, and organizational CDI initiativesDemonstrates basic knowledge of HIM standards of coding, coding clinics and applies to on-going evaluation of medical record documentationParticipates in the denial management processes for both DRG adjustments and for medical necessity denials as assignedMaintains current knowledge of regulatory and compliance requirements, and policies and procedures for utilization practices, processes and criteria. Assure compliance with Medicare and Medicaid utilization processes.Appropriately shares knowledge with coworkers.Participates in the development of actions for improvement.Reviews and analyzes regulatory reports and waivers. Identifies and shares with colleagues any actions to maximize hospital reimbursement, minimize risk, and identify opportunities for improvementRegular attends team meetings - provides advanced notice if going to be missed and appropriately seeks information missedExemplify satisfactory attendance and punctuality record as set forth by CHS policiesExemplify a professional image in appearance, manner and presentationMaintains patient confidentiality in the provision of quality careIs flexible in assuming other appropriate responsibilities not noted aboveRequirements: Education -Bachelors in nursing preferred, or Associates Degree with 3-5 years of inpatient clinical experience. CCDS, CDIP, CCS, CCS-P, or CPC Certification preferred.Experience - Minimum 2 to 3 years' experience in an acute care role. Knowledge of federal, state and accreditation standards. Requires strong verbal and written communication skills, organizational, critical thinking and problem-solving skills. Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly. Knowledge of pertinent Federal, State, and local laws, codes, and regulations. Physical Requirements - Ability to stand, sit or ambulate for long periods. Ability to transport self to hospital as needed. Ability to ambulate freely around nursing units. Use of hands and fingers for keyboard and computer data entry into EMR.