Medical Graduate, Physician Assistant, or Registered Nurse with current CA License
Minimum 1 year of CDI experience in an acute care setting
Strong multitasking abilities to manage workload effectively
Excellent customer service skills
Proficient written and verbal communication skills in English
Ability to communicate clearly with physicians
Computer literacy and proficiency required
Responsibilities
Conduct concurrent and retrospective reviews of inpatient medical records
Identify and resolve documentation gaps through physician queries
Coordinate daily department operations and troubleshoot issues
Facilitate improvements in medical record documentation quality
Audit patient claims for medical necessity denials and identify patterns
Participate in case management meetings to discuss clinical documentation
Educate staff on documentation guidelines and compliance standards
Benefits
Comprehensive health insurance options
Retirement savings plan with employer match
Paid time off and holidays
Continuing education opportunities
Supportive work environment focused on professional growth
Full Job Description
Position Summary
The CDI Specialist Level II is responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate if clinical documentation is reflective of medical necessity, quality of care outcomes and reimbursement compliance for acute care services provided. Works closely with the medical staff to facilitate appropriate clinical documentation of patient care. Other responsibilities include conducting initial and extended-stay concurrent reviews on all selected admissions and documenting findings.
Essential Job Functions / Major Areas of Responsibility
The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position.
Reviews inpatient medical records, meeting all department productivity goals, for identified payor populations as directed on admission and throughout hospitalization and identifies potential gaps in physician documentation. Ensures that clinical documentation reflects the level of service rendered to patients in a complete, accurate and compliant manner.
Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process, meeting department productivity goals. Follows up with the physicians to get resolution of all queries prior to patient's discharge to ensure accurate quality data and appropriate reimbursement whilst maintaining up to date DRG. Assists coders in follow-up on queries and clarifications to physicians done retrospectively post patient discharge.
Coordinates the daily operations of the department, troubleshooting and resolving issues as they occur. Educates others on documentation guidelines on an ongoing basis. Performs as a role model and consistently demonstrates an advanced level of expertise and enhanced communication skills.
Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through comprehensive auditing and evaluation of the medical record. Collects and analyzes data to provide reports and make recommendations. Works collaboratively with Performance Improvement Department to improve clinical documentation for compliance in quality of care measures.
Performs the duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and all regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
Reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician. Follow-up in improving clinical documentation to reduce such denials. Works collaboratively with health information management coding staff, physicians and financial services to resolve payment denials and documentation issues.
Regularly participates in scheduled case management meetings and actively exchanges information pertaining to clinical documentation, plan of care affecting coding and reimbursement.
Required Qualifications
CDIP or CCDS
Medical Graduate, Physician Assistant or Registered Nurse (Current CA License)
Minimum 1 year of previous practical floor CDI experience in an acute care setting
Ability to multitask and maintain a work pace appropriate to workload
Must demonstrate customer service skills appropriate to the job
Excellent written and verbal communication skills in English
Ability to effectively communicate with physicians in a clear and concise manner
Computer literacy and proficiency
Hospital Fire and Life Safety Card (Los Angeles City Employees only)
Preferred Qualifications
CCS
Physical Requirements
Indicate physical requirements for performing the essential functions of the job by double clicking and selecting 'checked' on the boxes below. These are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable, state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation.
Standing - Frequently
Walking - Frequently
Sitting - Frequently
Reaching with Hands and Arms - Occasionally
Climb or Balance - Occasionally
Stooping, Kneeling, Crouching, or Crawling - Occasionally
Talking - Frequently
Hearing - Constantly
Seeing - Constantly
Performing repetitive motions with arms or hands - Frequently
Lifting, carrying, pushing or pulling up to 10 lbs - Constantly
Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally
Lifting, carrying, pushing or pulling up to 50 lbs - None
Lifting, carrying, pushing, or pulling greater than 50 lbs - None
