Quality Improvement CDI Specialist

ABOUT NCH

NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System(TM) and we're proud to : Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.

JOB SUMMARY

The Quality Improvement Clinical Documentation Integrity Specialist (QI-CDIS) responsibilities include comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, act as a liaison between coding and CDI to resolve DRG or other code discrepancies, collaborate with CDI Liaison to educate CDI team based on opportunities identified in second level reviews and work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and / or provider education. The QI-CDIS will collaborate closely with Coders, Coding Educators, Coding Quality Auditors, Case managers, Quality Department and Providers to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards. Will provide other duties as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Other duties may be assigned.

Analyzes and interprets clinical data to identify gaps, inconsistencies, and / or opportunities for improvement in the clinical documentation and queries the provider using concurrent / retrospective query process following ACDIS / AHIMA Guidelines for Compliant Query Writing (2022).

Completes comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and / or code discrepancies; low acuity DRGs, medical / surgical DRGs without cc / mcc capture exceeding the expected GMLOS, mortality / discharge to hospice reviews to ensure documentation supports risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnosis as identified for potential missed opportunities to clarify documentation or clinically validate a diagnosis.

Acts as a liaison between the Coding Department and the Clinical Documentation Integrity Specialist to reconcile discrepancies in code and / or DRG assignment

Communicates findings of secondary reviews to respective Clinical Documentation Integrity Specialist for educational opportunities / outcomes.

Collaborates with CDI liaison / quality auditor when educational needs are identified from second level reviews.

Documents and tracks second level reviews and results. Shares this information with staff at regular scheduled CDI team meetings as well as other meetings (i.e. UM / Quality etc).

Collaborative interaction with physicians and / or other clinicians to enhance understanding of the CDI program goals; ensure the medical record can be coded accurately to accurately reflect complexity / acuity of each patient encounter.

Spends most of the work weeks on-site at the hospital as a resource, developing relationships and educating.

EDUCATION, EXPERIENCE AND QUALIFICATIONS

Minimum of Associate Degree required; Bachelor's Degree preferred.

Licensed as a Registered Nurse in the state of Florida.

5+ years CDI auditing / SLR or education experience; coding experience; or previous CDI experience in an academic institution; or 3+ years CDI auditing / SLR or education experience; coding experience; or previous CDI experience in an academic institution with 2+ years of leadership experience.

Team leading experience preferred.

Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) Certification required.

Advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an inpatient setting.

Strong understanding of coding application, rules, and guidelines.

Ability to formulate clinically, compliant and credible physician queries as per guidelines set forth in the AHIMA / ACDIS query practice brief.

Working knowledge of federal, state, and private payer regulations as well as applicable organizational policies and procedures.

Experience in MS-DRG and APR-DRGs, risk adjustment, HACs and PSIs, O / E mortality, and LOS.

Working knowledge of quality improvement theory and practice, core measures, safety, and other required reporting programs.

In-depth knowledge of MS-DRG payer issues, documentation opportunities, coding guidelines and changes to include Coding Clinic, and clinical documentation requirements.

Excellent verbal and written communication skills, analytical thinking, and problem solving with strong attention to detail.

Proficiency in organizational skills and planning, with an ability to multitask in a fast-paced environment.

Experience interacting with and educating medical staff and clinical support staff.

Proficiency in computer use, including database and spreadsheet analysis, presentation programs, word processing, and internet research.

Computer experience, especially with electronic medical record (EPIC) computerized encoder products (3M360 Encompass clinical application).

Proficiency in Excel and PowerPoint.

Intermediate computer knowledge : Microsoft Word, Excel, Outlook, and Windows