Clinical Documentation Improvement Specialist - Smithtown, United States - Catholic Health

Catholic Health
Catholic Health
Verified Company
Smithtown, United States

3 weeks ago

Mark Lane

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Mark Lane

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Description
Catholic Health is one of Long Island's finest health and human services agencies.

Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities.

We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes - to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace


The Clinical Documentation Improvement Specialist is responsible for improving the overall quality and completeness of clinical documentation within the inpatient record.

Performs concurrent reviews, facilitates modifications to the clinical documentation to accurately reflect the severity of illness and risk of mortality through extensive interaction with physicians, coding and other health care professionals; serves as a resource to improve capture and accuracy of the final coded DRG; able to meet daily production expectations, while impacting on the integrity of the in-patient record.

This position requires attention to detail and is production based.


DUTIES/RESPONSIBILITIES:


  • Conducts admission/continued stay reviews accurately using the coding guidelines and documentation guidelines to clarify conditions/diagnoses and procedures where inadequate or conflicting documentation exists.
  • Analyzes and interprets clinical data to identify gaps, inconsistences, or opportunities for improvement in the clinical documentation and appropriately queries the provider using a compliant query based on the AHIMA Guidelines for compliant query practice.
  • Follow open queries to ensure physician response.
  • Validates DRG assignment with medical record documentation, ICD10Official Coding guidelines and supporting clinical indicators.
  • Facilitates and secures accurate clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients.
  • Demonstrates knowledge of DRG payor issues, clinical documentation requirements and referral policies and procedures.
  • Develops collaborative relationships and promotes team work with coworkers and other departments.
  • Maintains a positive and supportive attitude towards the mission and goals of Catholic Health Services.
  • Educates members of the team on clinical documentation opportunities, coding and reimbursement issues as well as performance improvement opportunities and methods.
  • Assists in educating physicians regarding documentation to the highest level of specificity of all conditions and complications being addressed and treated.
  • Collaborates with HIM staff to insure proper code assignment.
  • Maintains strict patient confidentiality, adhering to HIPPA Guidelines.
  • Refers quality issues (HAC/PSI) to the appropriate resource.
  • Performs validation of ICD10CM/PCS codes after coding and prior to bill drop.
  • Proficient in assigning baseline and final MS/DRG and APR DRG in the CDI tracking tool utilizing coding and reimbursement tools, with knowledge of CDI impact on the case.
  • Proficient in accurately entering queries and MD/MLP responses in the CDI tracking tool.
  • Proficient in data entry and completion of CDI reviewed cases in the CDI tracking tool with attention to detail in order to avoid missing data.
  • Knowledge of current insurance denial trends and CDI's role in denial prevention.
  • Participates in seminars and workshops to keep current with all coding revisions.
  • Maintains credentials by obtaining adequate continuing education:
  • Must have strong current clinical knowledge and be able to collaborate with healthcare professionals in an efficient effective professional manner.
  • Must have excellent communication skills, both verbal and written.
  • Possesses the ability to educate health care professionals in various settings.
  • Demonstrated proficiency in Microsoft Work, Excel, Windows and Power Point required. Must be self directed and willing to mentor new staff entering the specialty as well as possessing the ability to meet production expectations and quality of review standards.
  • Must be able to meet or exceed deadline completion times regarding report submissions and bill hold reconciliation. Responsibilities to include other duties as assigned. Adheres to all approved AHIMA coding guidelines.

Education:


  • Registered Nurse (BSN preferred), Nurse Practitioner or Physician Assistant licensed to practice in the State of New York, required
  • Completion of ICD10CM/PCS coding class within 6 months of employment.
  • CCDS certification required within 2 years of hire date.

Skills:

Chart review skills with ICD-10-CM/PCS experience preferred.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided,
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