Additional Information About the Role

The Clinical Documentation Quality Coordinator (CDQC) is an advanced Clinical Documentation Specialist (CDS) at the enterprise level who uses extensive Clinical Documentation Improvement (CDI) experience to perform second level reviews of complex clinical cases and focused reviews of target case populations prior to final coding and billing across BJC. The CDQC responds to concurrent review requests from CDSs across the system, provides guidance to CDSs and coders to reconcile DRG mismatches, approves the withdrawal of queries, and escalates unanswered queries to Physician Champions. Drawing on his/her advanced CDI knowledge, the CDQC regularly analyzes data and reports to identify hospital/enterprise trends, areas of opportunity and provides education to facility-based CDSs and physicians based on this analysis. This position also performs focused second level reviews in mortality reviews, PSI reviews, and other identified projects indicated through data analysis.

Responsibilities

Reviews clinical documentation to facilitate the accurate representation of the severity of illness, expected risk of mortality, and complexity of care by improving the quality of the physician's clinical documentation; identifies high impact cases and risk areas and performs second level reviews for additional opportunities on complex cases; performs post-discharge, pre-bill reviews of target case populations; queries physicians for additional documentation; validates the appropriateness of coder (CDC I, I & III) requests; responds to Coding Quality Coordinators (CQCs) requests for review from a clinical perspective; assists with query escalation to the Physician Champions.

Demonstrates a thorough understanding of the MS-DRG system, CCs/MCCs, impact on quality, and CMI as well as ICD-10 coding systems and the guidelines related to clinical documentation improvement; serves as a resource for the Clinical Documentation Specialist (CDS) team; utilizes hospital coding code set, policies and procedures, federal and state coding reimbursement guidelines, and the Coding Clinic Guidelines to assign work; reviews patient records throughout hospitalization that have been identified as focus DRG by regulatory agencies; initiates physician interaction when abnormal ancillary test findings, ambiguous, missing or conflicting information is in the medical record.

Leads provider engagement, relationship establishment and maintenance for shared accountability related to enterprise CDI and documentation improvement efforts, with all providers across the enterprise.

Leads enterprise functional teams for educations, standard queries, standard process & technology, analytics, etc.; acts as a consultant to quality managers, management team, medical staff and health care staff regarding core measure performance and clinical documentation opportunities; leads and manages content development and presentation to key healthcare providers, education resulting from the analysis of clinical and financial information.

Establishes enterprise standards; identifies enterprise trends, variances, deficiencies, and problems utilizing aggregated data and information as part of the integrated clinical documentation improvement program; conducts provider and group level CDI data trend analysis, identifies issues and proposes solutions to leadership.

Minimum Requirements

Education

Bachelor's Degree

- Nursing
Experience

5-10 years

Preferred Requirements

Education

Master's Degree

Licenses & Certifications

Cert Clinical Documentation

Cert Doc Improve Practitioner

Benefits and Legal Statement

BJC Total Rewards

At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

To learn more, go to our Benefits Summary

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.