Clinical Documentation Improvement Specialist

DESCRIPTION

Job Title: Clinical Documentation Improvement Specialist

Job Summary:
Responsible for working collaboratively with Senior Managers and MAPMG in the development and implementation of HIMS and Coding activities and programs that ensure high quality, effective documentation and coding requirements that meets HIMS Medicare targets and goals.

To facilitate the accurate representation of the severity of illness by improving the quality of the clinical documentation and ensure constant compliance readiness state for HIMS and Coding department by assessing potential vulnerabilities through systematic and appropriate gap analyses, interventions and corrective actions.

Major Responsibilities/Essential Functions:
Implements quality review processes to ensure appropriate clinical documentation is captured to support diagnosis and to ensure the level of service rendered to all patients is accurately reflected in the record.
Reviews encounters against data mining reports to ensure all identified clinical indicators for focused HCCs (hierarchical chronic conditions) are documented or clarified as outlined in department procedures related to the query process.
Monitors and screens cases for quality concerns or issues related to quality improvement processes.
Identifies and collects appropriate data; incorporates quality improvement tools and methodology in all assignments.
 Provides staff support for coding improvement activities on a regional or a departmental level.
Works closely and collaboratively with the HIMS management leadership and Quality department on accreditation and licensing requirements to ensure all documentation is compliant with local, state, federal and accreditation requirements.
Acts as a liaison and facilitator for quality reports related to database tracking, quality trends and analysis, and specific focused studies, as assigned.
 Develops and maintains quality management systems, standards and criteria for reporting aggregate data and focused review findings and results in collaboration with the HIMS Management Leadership, medical group, and other designated departments.
Demonstrates familiarity with practitioner peer review methods to facilitate the process of unbiased case review with strict adherence to confidentiality and protection of sensitive information and findings.
dvances the quality and service improvement priorities of the region by using a variety of quality strategies, tools and techniques.
Performs other duties as directed.

Required Experience:
Six years of clinical experience (ie inpatient, ambulatory, clinical documentation, discharge planning, case management) working with Managed Care/HMO or equivalent health care experience required.
Three years experience in quality review or other related areas of practice required.
Demonstrated ability to conduct and interpret quantitative and qualitative analysis required.
Experience in quality improvement activities with ability to work as a consultant, facilitator, and colleague with other Quality Management staff, physicians and staff at all levels of the organization required.
Strong computer skills and use of databases required.

Desired Experience:
Master's degree in a healthcare related field preferred.
Professional Clinical License, such as: Register Nurse, Social Worker, Pharmacist, strongly preferred.
Understand coding classification systems such as, but not limited to ICD-9-CM, Current Procedural Terminology (CPT), healthcare common Procedural Coding (HCPCS), HCC, strongly preferred.
Registered Health information Technician (RHIT),or Certified Coding specialist (CCS) or Certified Professional Coder (CPC) preferred
Excellent written and verbal communication skills preferred.
Excellent interpersonal skills preferred.
Self motivation preferred.
Ability to work independently with minimal supervision preferred.

Required Education:
BSN or Bachelor's Degree in a healthcare related field required