CDI Specialist- Outpt- Population Health

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MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Must have one of the following qualifications:

• High School Diploma or Equivalent AND Graduate of Health Information Technology (HIT) or equivalent program with RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator) AND Three (3) years outpatient/ambulatory or inpatient acute care coding OR;
• Current West Virginia Licensed Registered RN (RN) AND Three (3) years clinical experience in outpatient/ambulatory or inpatient acute care setting OR;
• Current West Virginia Licensed Practical Nurse (LPN) AND Four (4) of clinical experience in  outpatient/ambulatory or inpatient acute care setting OR;
• High School Diploma or Equivalent AND CCS (Certified Coding Specialist) OR CPC (Certified Professional Coder) AND Three (3) years of outpatient/ambulatory or inpatient acute care setting OR;
• One of the above credentials AND Two (2) years of CDI experience OR;
• High school diploma or equivalent AND Five (5) years of CDI experience in the inpatient acute care setting

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Experience in Risk Adjusted Coding or Evaluation and Management highly desirable.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. In collaboration with the providers and staff, identifies first listed diagnosis, secondary diagnoses, pertinent HCCs, outpatient procedures, and documentation completeness in the outpatient/ambulatory setting.

2. Conducts initial encounter review, identifies documentation opportunities.

3. Identifies need to clarify documentation through quality audits in records and initiates communication with physician, nurse, or patient care coordinator by utilizing the appropriate “query” tools in order to capture the documentation in the medical record that accurately supports the patient’s severity of illness.

4. Provides information and ongoing education as necessary to providers and staff on documentation issues, guidelines, and unanswered queries.

5. Promotes compliance with CMS, Medicare documentation, and coding and billing regulations.

6. Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative levels.

7. Collaborates with the Population Health Department to ensure documentation meets quality initiative standards used for measuring and reporting ACO and provider outcomes.

8. Collects, analyzes and submits timely, accurate and complete reports of clinical documentation information used for measuring and reporting ACO and Provider outcomes data.

9. Facilitates in the education and training of new associates concerning clinical documentation improvement guidelines and processes. This may include providers, CDIs, coders, and other healthcare providers.

10. Works with the Coding Specialists on any issues that arise concerning documentation, providers, and queries to enhance the concurrent process to enable prompt coding.

11. May provide educational support in terms of clinical/coding or process at manager’s discretion and as need arises.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for long periods of time.

2. Must have visual and hearing acuity within the normal range.

3. Must have manual dexterity needed to operate computer and office equipment

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. May be exposed to standard patient care environment.

3. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.

4. May require travel.

SKILLS AND ABILITIES:

1. Must possess excellent written and verbal communication skills, as well as interpersonal skills necessary to communicate effectively.

2. Must possess the knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required.

3. Must possess the ability to accept mentoring, education and training from others.

4. Must meet quality and productivity standards.

5. Must be able to concentrate and maintain accuracy during constant interruptions.

6. Must possess the ability to prioritize job duties.

7. Must be able to adapt to changes in the workplace and work assignments.

8. Must possess organizational and time management skills.

9. Must possess the knowledge of anatomy, physiology and medical terminology.

10. Must possess analytical and problem solving skills

11. Must be proficient in office software programs.

12. Must be able to work independently with minimal supervision.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: