<p>Summary of Position Works under the supervision of the Manager, CDI AMHS who is responsible for ensuring the overall quality and completeness of clinical documentation. Facilitates and obtains appropriate clinical documentation for all clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care provided. This position is responsible for concurrent inpatient medical record reviews for Medicare, Medicaid, and all commercial payers. The Clinical Documentation Specialist (CDS) is required to generate queries and have follow-up discussions with physicians for clarification of ambiguous or conflicting documentation. The CDS provides ongoing physician education about coding and reimbursement and collaborates with various departments to include Case Management, Quality and HIM/Coding. CDS performs chart reviews as needed. Supports timely, accurate, and complete documentation and analysis of clinical information used for measuring and reporting physician and Hospital outcomes.# Educates all members of the patient care team on an ongoing basis.# Actively contributes to the morale and teamwork of the staff and facility, always presenting a positive attitude and patient-minded vision with patient satisfaction as the continuing goal. Functions as Clinical DRG denials specialist and, in doing so, reviews DRG denials from payers, submits written appeals including compelling arguments based on clinical documentation, recent medical literature review and contract language. The CDI specialist collaborates closely with the Coding denial specialist and with the Physician Advisor as needed and determines the appropriate course of action for second and third level appeals. Tracks all clinical DRG denials and trends the appeals outcomes. Primary Job Responsibilities: Uses software and Clinical Documentation Improvement (CDI) tools to conduct initial and follow-up concurrent reviews to validate documentation adequacy. Compares coding and reimbursement profile with national and state norms to identify variations requiring further investigation. Conducts trend analysis to identify patterns and variations in reporting practices and case-mix index. Queries physicians for clarification and specificity of documentation in accordance with hospital policy and the AHIMA Practice Brief: Developing a Physician Query Process. Consults with physician advisor when indicated by review results and /or query response. Maintains worksheets on all concurrent reviews. Maintains CDI tools used in data tracking and analysis: Query Log, CDI Scorecard(s) and reports. Coordinates final reporting of diagnoses with coding staff, providing clinical recommendations as needed. Develops and coordinates educational and training programs regarding appropriate documentation required for complete and accurate coding reporting In partnership with appropriate personnel, develops and implements standardized, organization-wide reporting guidelines and documentation requirements and develops and implements training and educational programs for physicians, coders, case managers and/or other affected personnel. Initiates corrective action to ensure resolution of problem areas identified during internal or external auditing and provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians. Demonstrates competency in the use of computer applications and DRG/APG/APC Grouper Software, OCE edits, and all coding convention and abstracting software and hardware currently in use by the Health Information Services Department. Reviews and responds to payor audits related to DRG assignment. Writes timely clinically supported appeals. Tracks all appeals to resolution. Collaborates closely with the Coding DRG denials specialist and with the Physician Advisor. Assists with quality improvement of the appeals process. Minimum Qualifications: Clinical Professionals (or RNs) preferred: Current valid New York State License.# At least three years# experience in utilization management, Health Information Management, acute care clinical nursing, Quality Improvement, or document review will be considered. ECFMG certification preferred. HIM Professionals: RHIT, RHIA and at least three years of experience with coding, abstracting and DRGs, APGs and APCs knowledge is required.# Competitive candidates will have: A solid working knowledge of ICD-10-CM coding principles and guidelines, SOI-ROM, HAC#s, PSI#s, PPCs and Value-Based Purchasing.### Be well versed in both outpatient and inpatient documentation requirements as well as possess clinical knowledge for proper code assignment and query request.# Thorough knowledge of medical terminology, pathophysiology, pharmacology and anatomy and physiology.# Working knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and reimbursement or willingness to obtain this knowledge.# Strong project and process management, leadership and interpersonal skills.# Excellent written and oral communication skills.# Critical thinking skills. Certifications: CCS or CDIP or CCDS#certification within 3 years of hire is expected. Required Skills, Abilities, and Attributes: Ability to organize and establish day-to-day priorities while utilizing critical thinking skills in all aspects of the job.# Must be able to multitask while remaining professional, focused, composed and positive. Excellent customer service skills and must display integrity, friendliness and compassion. Excellent verbal and written communication skills Must be able to establish an appropriate and effective rapport with others. Must be flexible to take initiative and embrace new opportunities to grow both personally and#organizationally. Problem solving skills. Proficient with Microsoft Office products: Outlook, Word, Excel and PowerPoint. Strong organizational skills. Effective interpersonal skills#and ability to work effectively in a hybrid work team, including physicians, coders, nursing and other personnel. Ability to work independently. Salary Range: $33.43 - $54.89 Pay Grade: 34 Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.</p> <p>Summary of Position</p> <p>Works under the supervision of the Manager, CDI AMHS who is responsible for ensuring the overall quality and completeness of clinical documentation. Facilitates and obtains appropriate clinical documentation for all clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care provided. This position is responsible for concurrent inpatient medical record reviews for Medicare, Medicaid, and all commercial payers. The Clinical Documentation Specialist (CDS) is required to generate queries and have follow-up discussions with physicians for clarification of ambiguous or conflicting documentation. The CDS provides ongoing physician education about coding and reimbursement and collaborates with various departments to include Case Management, Quality and HIM/Coding. CDS performs chart reviews as needed. Supports timely, accurate, and complete documentation and analysis of clinical information used for measuring and reporting physician and Hospital outcomes. Educates all members of the patient care team on an ongoing basis. Actively contributes to the morale and teamwork of the staff and facility, always presenting a positive attitude and patient-minded vision with patient satisfaction as the continuing goal. Functions as Clinical DRG denials specialist and, in doing so, reviews DRG denials from payers, submits written appeals including compelling arguments based on clinical documentation, recent medical literature review and contract language. The CDI specialist collaborates closely with the Coding denial specialist and with the Physician Advisor as needed and determines the appropriate course of action for second and third level appeals. Tracks all clinical DRG denials and trends the appeals outcomes.</p> <p>Primary Job Responsibilities:</p> <ul> <li>Uses software and Clinical Documentation Improvement (CDI) tools to conduct initial and follow-up concurrent reviews to validate documentation adequacy. Compares coding and reimbursement profile with national and state norms to identify variations requiring further investigation. Conducts trend analysis to identify patterns and variations in reporting practices and case-mix index. </li><li>Queries physicians for clarification and specificity of documentation in accordance with hospital policy and the AHIMA Practice Brief: Developing a Physician Query Process. </li><li>Consults with physician advisor when indicated by review results and /or query response. Maintains worksheets on all concurrent reviews. Maintains CDI tools used in data tracking and analysis: Query Log, CDI Scorecard(s) and reports. Coordinates final reporting of diagnoses with coding staff, providing clinical recommendations as needed. </li><li>Develops and coordinates educational and training programs regarding appropriate documentation required for complete and accurate coding reporting </li><li>In partnership with appropriate personnel, develops and implements standardized, organization-wide reporting guidelines and documentation requirements and develops and implements training and educational programs for physicians, coders, case managers and/or other affected personnel. </li><li>Initiates corrective action to ensure resolution of problem areas identified during internal or external auditing and provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians. </li><li>Demonstrates competency in the use of computer applications and DRG/APG/APC Grouper Software, OCE edits, and all coding convention and abstracting software and hardware currently in use by the Health Information Services Department. </li><li>Reviews and responds to payor audits related to DRG assignment. </li><li>Writes timely clinically supported appeals. </li><li>Tracks all appeals to resolution. </li><li>Collaborates closely with the Coding DRG denials specialist and with the Physician Advisor. </li><li>Assists with quality improvement of the appeals process. </li></ul> <p>Minimum Qualifications:</p> <p>Clinical Professionals (or RNs) preferred:</p> <p>Current valid New York State License. At least three years' experience in utilization management, Health Information Management, acute care clinical nursing, Quality Improvement, or document review will be considered. ECFMG certification preferred.</p> <p>HIM Professionals:</p> <p>RHIT, RHIA and at least three years of experience with coding, abstracting and DRGs, APGs and APCs knowledge is required.</p> <p>Competitive candidates will have:</p> <ul> <li>A solid working knowledge of ICD-10-CM coding principles and guidelines, SOI-ROM, HAC's, PSI's, PPCs and Value-Based Purchasing. </li><li>Be well versed in both outpatient and inpatient documentation requirements as well as possess clinical knowledge for proper code assignment and query request. </li><li>Thorough knowledge of medical terminology, pathophysiology, pharmacology and anatomy and physiology. </li><li>Working knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and reimbursement or willingness to obtain this knowledge. </li><li>Strong project and process management, leadership and interpersonal skills. </li><li>Excellent written and oral communication skills. </li><li>Critical thinking skills. </li></ul> <p>Certifications:</p> <p>CCS or CDIP or CCDS certification within 3 years of hire is expected.</p> <p>Required Skills, Abilities, and Attributes:</p> <ul> <li>Ability to organize and establish day-to-day priorities while utilizing critical thinking skills in all aspects of the job. </li><li>Must be able to multitask while remaining professional, focused, composed and positive. </li><li>Excellent customer service skills and must display integrity, friendliness and compassion. </li><li>Excellent verbal and written communication skills </li><li>Must be able to establish an appropriate and effective rapport with others. </li><li>Must be flexible to take initiative and embrace new opportunities to grow both personally and organizationally. </li><li>Problem solving skills. </li><li>Proficient with Microsoft Office products: Outlook, Word, Excel and PowerPoint. </li><li>Strong organizational skills. </li><li>Effective interpersonal skills and ability to work effectively in a hybrid work team, including physicians, coders, nursing and other personnel. </li><li>Ability to work independently. </li></ul> <p>Salary Range: $33.43 - $54.89</p> <p>Pay Grade: 34</p> <p>Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.</p>