Clinical Documentation Integrity, Second Level Reviewer

Job Description:

• Perform high-level, complex, secondary case reviews to facilitate and obtain appropriate provider documentation for clinical conditions or procedures
• Ensure accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes
• Perform secondary case reviews to identify potential gaps or opportunities to facilitate improved provider documentation
• Ensure clinical documentation accurately reflects the level of care rendered, severity of illness, risk of mortality, and clinical validation
• Apply advanced knowledge of CMS star rating, Vizient, and US News and World Report risk-adjustment systems to identify clinical documentation improvement opportunities
• Complete quality reviews focused on CDI quality elements, such as Mortality, Hospital Acquired Conditions (HAC), and other publicly reported patient quality or safety metrics
• Identify trends and key areas for improvement in querying, coding, and documentation integrity
• Demonstrate proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG
• Communicate and collaborate effectively with providers, HIM/coding, quality, CDI, and other members of the healthcare team

Requirements:

• Four (4) Year/bachelor’s degree required
• BSN/BS/BA in related field Required
• Graduate degree in Healthcare Administration, Informatics, Nursing, Leadership, Education or related field preferred
• Current RN or MD required
• CCDS or CDIP certification required
• Coding certification (CCS, CIC, or CPC) preferred
• At least three (3) years recent inpatient clinical documentation improvement (CDI) experience required
• Demonstrated extensive clinical knowledge
• At least three (3) years of direct patient care clinical experience in hospital setting preferred
• Proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG required
• At least one (1) year experience with mortality, PSI, HAC, or other quality-focused reviews required
• Knowledge of Vizient, Premier, US News and World Report, CMS star rating or similar risk-adjustment methodologies highly preferred
• Prior experience in an academic medical center (AMC) or large health system preferred
• Proficiency with Microsoft Office (Excel, PowerPoint, Word, Outlook) required
• Proficiency with CDI software and encoder required
• Experience with 3M 360 Encompass preferred

Benefits:

• medical
• dental
• tuition remission
• competitive salaries