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Coding Quality Spec-Cdi
Da Vinci Software
Rochester , MN 55902
Posted 4 months ago
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The CDI/Coding Quality Specialist works collaboratively as a subject matter expert to the Enterprise Operations Administrator providing assistance based on the vision, mission, philosophy and core values of the clinic through various projects ensuring appropriate clinical documentation/coding measures are present, along with ensuring quality metrics are being utilized. The CDI/Coding Quality Specialist assures compliance with external and internal measures for the CDI Program, assisting in review of reports such as PEPPER, CMI benchmarking, and other pertinent regulatory data. The CDI/Coding Quality Specialist identifies areas of improvement for the CDI program ensuring quality work is being performed. The CDI/Coding Quality Specialist will work to identify and share updates related to Coding Guidelines, OIG updates and AHA Coding Clinic changes (Annual/Quarterly) as they relate to Clinical Documentation Integrity. Additionally, the CDI/Coding Quality specialist will participate in reviewing, researching and identifying trends and opportunities of DRG changes/denials. May be asked to assist in development of teaching tools for both physicians and CDI staff members and perform pre-bill retrospective chart review on focus projects. Must be self-motivated and able to work as part of a team with minimal supervision. Must possess the ability to work well within a creative and challenging work environment.Qualifications:
Additional Experience and/or
- A Bachelor's Degree is required with at least five years' experience in Revenue Cycle leadership with supervisory and project management experience.
- Five years in-patient coding and DRG auditing along with two years' experience in CDI is required.
- In-Patient Coding Certification (CCS through AHIMA) and Outpatient Coding Certificate(s) (CPC and/or COC through AAPC) as well as CDI Certification (CCDS through ACDIS or CDIP through AHIMA) is required.
- At least 1 year of external payer auditing required.
- Experience in developing in-patient teaching tools (including developing compliant CDI physician queries) for physicians/NP/PA's/Coding/CDI staff required.
- Minimum of three years of experience related to DRG denials is required.
- Excellent communication, problem-solving and decision-making skills along with relevant experience including lead roles, project/committee leadership, and experience educating physicians, nurses and other staff principles of Coding and CDI is required.
- Must demonstrate proficiency in ICD-10 CM/PCS, ICD-9-CM, MS-DRG methodology, APR-DRG methodology, Clinical Validation, CPT, HCPCS, HCCs.
- Must demonstrate proficiency of IPPS and OPPS subject matter.
- Must demonstrate an understanding of HACs, PSIs, Core Measures, Mortality Reviews and other Quality measures as related to CDI and Coding.
- Experience in Revenue Cycle Leadership and CDI program Leadership.
- Experience in data analytics in order to identify trends and opportunities.
- Bachelor's Degree AHIMA CCS AHIMA CDIP or ACDIS CCDS is required.
- Computer experience in Microsoft Office applications such as Word, Excel, Powerpoint.
- Previous experience with external accrediting bodies (e.g., NCQA, JCAHO) helpful.
- Knowledge of Medicare and Medicaid guidelines and understanding of managed care and commercial review experience preferred.
- Experience in developing and implementing new processes, services, or business lines preferred.
- Experience Cerner Midas, Epic and Optum along with experience with Advisory Board products (i.e. Crimson, Compass) preferred.
- This position is an exempt position and will be located in Arizona and has a telecommute option with a minimum of 10% travel required at the discretion of Enterprise Operations Administrator CDI.
- Full Time Teleworking Allowed