Job Summary
The Clinical Documentation Improvement Manager will complete timely documentation reviews to assign principal diagnosis and pertinent secondary diagnoses for inpatients admitted emergently, urgently and electively and outpatient services for completeness. Works collaboratively with the Clinical Documentation Improvement (CDI) Staff to facilitate documentation within the medical record that supports patient's severity of illness and risk of mortality utilizing strong communication skills with physicians, case managers, utilization reviewer, nurse, or other healthcare professionals, utilizing appropriate querying tools to capture needed documentation. Manages audits for external Centers for Medicare & Medicaid Services (CMS) Recovery Audit Tracker (RAC) Audit results. Reviews monthly audits of all internal coders for accuracy. Using broad knowledge and understanding of the Medical Severity (MS) Diagnosis-Related Group (DRG) system, complication or comorbidity (CC)/major complexity or comorbidity (MCC), impact on quality, and CMI as well as ICD-10-CM/PCS coding systems and the guidelines related to CDI.
General Administrative Responsibilities
Collective Bargaining
Discipline
Supervision
Management
General Administrative Responsibilities continued
Typical Duties
Typical Duties continued
Minimum Qualifications
* Bachelors degree from an accredited college of university
* Licensed as a Registered Professional Nurse in the State of Illinois, Registered Health Information Technician (RHIT), OR a Registered Health Information Administrator (RHIA)
* Four (4) years of experience in acute care nursing, as a Registered Health Information Technician (RHIT), and/or as a Registered Health Information Administrator (RHIA)
* Two (2) year of experience within the last five (5) years working in Clinical Documentation Improvement
* Two (2) years of experience supervising and/or managing staff
* Two (2) years of experience working with Case Mix, ICD 10 coding, principal and secondary diagnoses, procedures, complications, comorbidities, severity and patient mortality risk
* Current experience with federal, state, and other payers' regulatory requirements and criteria including, but not limited to, Medicare and Medicaid
* Prior experience working in a hospital or health care environment
* Must be detail oriented for clinical documentation review
* Must be familiar with electronic health record systems, i.e., Cerner or Siemens
Preferred Qualifications
* Licensed as a Registered Professional Nurse in the State of Illinois
* Five (5) years of acute care nursing experience or as a registered health information administrator
* Two (2) years of experience within in the last three (3) years working in Clinical Documentation Improvement
* Four (4) years of experience working with Case Mix, ICD 10 coding, principal and secondary diagnoses, procedures, complications, comorbidities, severity and patient mortality risk
* Two (2) years of experience with federal, state, and other payers' regulatory requirements and criteria including, but not limited to, Medicare and Medicaid
* Current experience with InterQual and/or Milliman Care guidelines
* Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCSP), or Certified Professional Coder (CPC)
* Registered Health Information Administrator (RHIA)
* Knowledge and application of AHIMA, and/or ACDIS Ethical Standards
* Knowledge of, but not limited to, current CMS coding guidelines and methodologies, MS-DRGs, APR-DRGs, HCCs; ICD-10-CM/PCS and AMA CPT coding guidelines and conventions
* Broad knowledge of quality medical documentation and regulatory directives
* Interpersonal, verbal, written communication skills in dealing with inter and intradepartmental activities
* Critical thinking skills with the ability to assess, evaluate, and teach
* Organizational and analytical thinking skills
* Ability to develop and maintain supportive, collaborative relationships with Physicians and other clinical professional
* Ability to provide concise reports of activities and results.
* Ability to work independently in performing duties with minimal supervision with a high degree of self-motivation
* Ability to teach in a large group setting to educate healthcare providers about current documentation standards
* Ability to track activities and communication across multiple physician services and forums
* Ability to work with clinical manager, case management, and physicians to make clinical documentation improvements, i.e. change clinical documentation processes
* Ability to analyze problems and issues and understand the regulatory and reimbursement impact of those decisions
* Ability to become adaptable and self-motivated by staying abreast of CMS rules and regulations and incorporating those changes into daily practice
* Proficiency in Microsoft Office Suite (Word, Excel, and PowerPoint)
Physical and Environmental Demands
This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.