CDI Validation Specialist

POSITION SUMMARY:

The CDI Validation Specialist assists the CDI Manager with oversight, evaluation, and analysis of CDI functions including efficiency, accuracy, continuing education needs, and overall quality. This individual identifies individual education needs of Clinical Documentation Specialists and collaborates with CDI Manager, IP Coding Manager, and IP Coding Validation Manager to develop appropriate training materials. The primary goal of ensuring the documentation in the chart identifies all clinical findings, diagnoses and procedures; and are appropriately and clinically supported. The CDI Validations Specialist will work with the CDI Manager to leverage performance, providing feedback and influence to continually improve documentation results thereby impacting key performance indicators.

Position: CDI Validation Specialist        

Department: Clinical Documentation

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

The CDI Validation Specialist functions primarily as an interdisciplinary auditor and educator focusing primarily on ensuring physician documentation is complete, accurate and representative of the care provided to the system’s patients.  To that end, the CDI Senior Validator will have access to physicians and clinical staff to participate in and assist in ensuring the ongoing documentation improvement effort is successful. The CDI Senior Validator will report directly to the CDI Manager. 

Other functions include the following:

• Monitors CDI staff accuracy, data quality and integrity.

• Monitors CDS review process for content, timeliness and accurate diagnosis and procedure assignment in determining a working DRG.

• Monitors concurrent queries for compliancy, accuracy, clarity, and timeliness.

• Audits clinical documentation specialists retrospectively to assess for completes of chart review and query compliance including missed query opportunities, accurate coding, and adherence to AHIMA/ACDIS compliant query guidelines/standards

• Collaborates with CDI manager to identify, coordinate, and implement CDI specialist ongoing education and feedback based on identified opportunities for improvement via auditing.

• Assists in orientation and training of new clinical documentation specialists

• Reviews and analyzes denial claims and denial data to provide support in denial prevention strategies via clinical validation query process and education to CDI specialists.

• Contributes to departmental and organizational quality performance goals, including auditing mortality and readmission cohorts to identify opportunities for improvement. Coordinate and implement CDI specialist education based on identified opportunities. 

• Collaborates with CDI manager to create and update documentation tools, processes, procedures, and work flows on an ongoing and as needed basis.

• Reviews charts concurrently with no MCC/CCs, low SOI/ROMs and LOS not supported by working DRG.

• Identifies and educates CDI with missed query opportunities.

• Assists CDI manager with final DRG validation when there is a discrepancy between CDS and coder.

• Collaborates with the CDI Manager and identifies opportunities for performance improvement activities on processes.

• Collaborates with CDI Manager, IP Coding Manager, and IP Coding Validation Manager to strategize appropriate training methodology for individual issues.

• Provides timely appropriate feedback to CDI Manager on any performance improvement plans for CDI staff.

• Collaborates with other CDCI department managers to identify areas for improvement and solutions for process improvement.

• Assures documentation is compliant with federal and state regulations, coding guidelines and hospital policies.

• Remains up-to-date in clinical and coding/documentation-related materials, including CDS best practices as defined by ACDIS as well as ICD-10-CM/PCS, AHA Coding Clinic guidelines for coding and reporting and MS-DRG/APR-DRG classification systems.

• Monitors regulatory and reimbursement changes.

• Serves as resource for CDI informational needs and updates CDI on coding changes, medical science and CDI practice standards.

• Provides guidance, support and expertise to the CDI specialists

• Track trends in documentation concerns and implementing solutions for improvement.

• Uses leadership and critical thinking skills to identify opportunities for team processes and engagement

• Recommend solutions for improvement when deficiencies are identified.

• Provides CDI specialists, coders, and coding validation specialists with clinical feedback to assist in accurately capture diagnoses and/or opportunities for querying physicians post discharge for additional information.

• Evaluates the success of concurrent documentation improvement on an ongoing basis.

• Advances professional growth and development through participation in educational programs and workshops and maintaining knowledge of industry standards and practices.

• Assists manager, when requested, in the development of APR/DRG/query response physician reports.  Maintains complete confidentiality of patient information in addition to hospital and individual physician practice pattern data.

• Assumes operational oversight of CDI department in the absence of the CDI manager. 

• Adheres to all BMC’s RESPECT behavioral standards.

• Other duties as assigned.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

REQUIRED EDUCATION AND EXPERIENCE:

• Bachelor’s degree (or equivalent) in nursing, health information management or related field and at least five years (5) years experience in clinical documentation, or equivalent combination of education and experience, required.

PREFERRED EDUCATION AND EXPERIENCE:

• Master's degree

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Licensed RN

CERTIFICATES, LICENSES, REGISTRATIONS PREFERRED:

• CCDS, CDIP

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Demonstrate advanced knowledge of clinical documentation integrity practices, policies, workflows, and analysis.

• Critical thinking, analytical and problem solving skills

• Highly organized with strong project/task management skills

• Knowledge of federal, state and payer specific regulations, policies and guidelines pertaining to coding (inpatient or outpatient), documentation requirements and billing

• Experience with 3M Encoder/Grouper, SMART software preferred

• 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.

• Excellent written and verbal communication skills.

• Excellent critical thinking skills.

• Demonstrated employee and medical staff relationships in the past and has the ability to maintain those going forward.

• Working knowledge of inpatient admission criteria.

• Ability to work independently in a time-oriented environment.

• Computer literacy and familiarity with the operation of basic office equipment.

• Assertive personality traits to facilitate ongoing physician communication.

• Ability to be adapt to changes in the workload, to work independently and effectively prioritize work assignments

• Working knowledge of Medicare reimbursement system and coding structures preferred, but not required.

• Familiarity with physician practices, health information, case management or related healthcare discipline

• Familiarity with all government health care reimbursement systems

• Have experience working collaboratively with diverse groups in a health care environment 

• Demonstrated success in interacting effectively with physicians

• Excellent speaking, writing and teaching skills

• Proficient with standard Microsoft programs (i.e. MS Word, Excel, PowerPoint, Outlook) and web browsers.

• Ability to analyze large amounts of data to identify trends.

• Ability to provide direction and development to employees by coaching, identifying training needs, assigning progressively challenging projects, and assisting in career development planning.

Equal Opportunity Employer/Disabled/Veterans

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