Senior Consultant - Clinical Documentation Specialist

Senior Consultant - Healthcare Clinical Documentation Specialist

Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.

As a Senior Consultant in our Regulatory, Risk, & Forensic Healthcare Practice, you will have the opportunity to work on multiple projects leveraging your education and prior work experience to help our clients more confidently make decisions to drive performance. You will help our clients embrace change, grow their business, accelerate performance, and navigate periods of crisis or controversy and emerge resilient. Projects may be aligned to the following areas and include:

• Operational Improvement: For business process that include significant clinical documentation and regulatory requirements, you will improve efficiency and business outcomes by leverage process improvement, technology innovation and operating model evolution.
• Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
• Strategic Risk: Helping clients to embrace their most significant regulatory, clinical documentation, and operational risks, by enabling senior health care executives to plan for, spot, assess, manage, and respond to those risks to either avoid harm or to embrace risks as opportunity.
• Regulatory Response: Supporting clients with their most pressing regulatory and operational challenges. Helping them to identify, remediate, monitor, and manage enterprise risks and create value through implementing a compliant, resilient enterprise. Includes helping clients manage and respond to internal and external investigations, regulatory concerns, financial concerns and other business controversy.

A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of clinical documentation. A CDS also identifies opportunities for accurate documentation in order to appropriately identify the severity and acuity of the patient. A CDS:

• Is knowledgeable regarding clinical documentation standards and clinical indicators which drive reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment
• Has strong interpersonal skills to collaborate with clinicians, physicians, NP/PAs, ancillary departments, Quality, Case Management, Finance, Revenue Cycle, and Coders
• Other skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities
• Completes and coordinates the preparation of reports and analyses, identifies adverse trends, makes appropriate recommendations for improvement, and tracks progress

Job Duties and Responsibilities:

• Analyze medical records for inpatient and outpatient service areas for accuracy of coding and documentation to ensure regulatory compliance
• Apply knowledge of medical terminology, disease conditions and procedures to evaluate clinical documents
• Monitor diagnoses, treatments, and follow-up entries in medical records to lead to coding accuracy
• Identify gaps in clinical documentation and request missing information from the appropriate providers
• Develop and implement plans for both formal and informal education of physicians, CDI team, health information management and other clinical staff
• Develop in-service education tools as necessary for physicians, CDI team and ancillary staff and assist physician champion to conduct education as needed
• Train CDI team, physicians and other medical staff on suitable documentation processes to ensure consistency and accuracy of clinical documentation
• Interpret and prepare clinical reports for healthcare professionals, executives and other stakeholders to discuss documentation trends, outcomes and go forward plans
• Meet with healthcare stakeholders to explain findings and facilitate actions based on recommendations
• Participate in and facilitate executive meetings to explain CDI benchmarks, KPIs and demonstrate overall program accomplishments and challenges through analytics and dashboards
• Conducts and monitors the provider education to ensure appropriate and timely usage of face-to-face meetings, conference calls, Web Conferencing and group facility meetings
• Create and deliver presentations at local and national conferences and/or client meetings
• Keep up to date with advancements changes in regulations pertaining to coding, clinical documentation and health information technology

The successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines
• Ability to provide clear guidance to others

Required Qualifications:

• Bachelor's degree in nursing, medical degree, or physician assistant required
• Current Registered Nurse (RN) license required
• Certified Clinical Documentation Specialist CCDS (inpatient) certification required.
• A minimum of 3 years of experience in acute inpatient settings
• Extensive experience in collecting, interpreting and communicating medical information to select appropriate clients with recommendations and plan of action
• Knowledge of care delivery documentation systems and related medical record documents
• Knowledge of age-specific needs and the elements of disease processes and related procedures
• Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes
• Strong analytical skills
• Ability to keep up to date with advancements and regulations in medical coding and clinical documentation
• Proficient in MS Word, Excel and PowerPoint preferred
• Proficient in Electronic Medical Record (EMR) software, such as Epic, Cerner, Allscripts, etc. required
• Excellent verbal and written communication skills with small and large group presentation skills
• Ability to work independently and with multiple teams in a time-sensitive environment
• Ability to travel 50-70%, on average, based on the work you do and the clients and industries/sectors you serve.
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or in the future.

Preferred Qualifications:

• Master's degree in Clinical Informatics, Business Administration, Nursing and related health fields preferred
• Case Management or Medical coding certification a plus (CRC, CCA, CCS-P, CCS, CPC, CDIP, CCM)
• Experience as clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG Validation and health IT preferred
• Knowledge of Medicare reimbursement system and coding structures preferred
• In-depth knowledge and experience in medical terminology, medical coding, and ICD-10-CM/PCS, IPPS payment system is a plus
• Experience in quality measurement, quality improvement, and value-based payment models
• Proven applicable CPT and ICD-10 coding experience; APR-DRG, MS-DRG and HCC assignment
• Other revenue cycle experience including conducting charge capture and coding reviews for compliance with billing and coding regulatory requirements
• Experience in program and/or project management for technology implementations using third party software
• Knowledge of process excellence (Six Sigma, LEAN, Design Excellence), certifications preferred
• Experience training, educating and coaching