Memorial Healthcare

Job Summary:

Under the direct supervision of the Director of Health Information Management the Professional CDI Specialists is responsible for reviewing outpatient documentation for accuracy in the support of coding, quality measures and clinical requirements. Provide feedback to providers to improve clinical documentation and facilitate ongoing documentation improvement to meet all requirements of the medical record. Coding reviews include routine and periodic assessment of diagnoses and procedures performed with adherence to established coding guidelines of ICD-10-CM (International Classification of Disease), CPT (Current Procedural Terminology), Governmental and Third-party carriers. Responsible for developing and implementing ongoing coding training and auditing of medical records to ensure compliance with CMS’s coding and documentation guidelines.The CDI Specialist is responsible for improving the overall quality and completeness of clinical documentation.

Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

JOB RELATIONSHIPS

Responsible to: Director of Health Information Management

Workers Supervised: None

Interrelationships: Practice Management, Medical Staff, Nursing, Provideroffices, Billing, Medical Records, Coding Department, Quality Improvement, Internal and external customers.

PRIMARY JOB RESPONSIBILITIES

1. Manages coding compliance standards, policies and procedures to ensure conformity with coding guidelines (CMS, AAPC) for all MMA providers.
2. Reviews clinical documentation to determine adherence to established Government and third party billing guidelines, AMA, AAPC, CMS and coding policies as necessary.
3. Provides coding education to physicians, coders, and other staff regarding standards for medical record documentation and the correct use of CPT-4 and ICD-10 codes.
4. Queries physicians regarding missing, unclear, or conflicting documentation by requesting and obtaining additional documentation within the record when needed.
5. Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the medical record.
6. Effectively resolves coding inquiry issues through participation in the coder email process, patient dispute resolution process, and general coding education emails.
7. Assist coders with any MMA providers and MA errors i.e. new codes, missing diagnoses, procedures documentation.
8. Review documentation to make sure that providers are assigning the appropriate Evaluation and Management codes and provide necessary education.
9. Complete coding audit/review of at least 10-15 encounters per provider at a minimum of every 3-6 months.
10. Complete coding audit/review of 100% of encounters for new providers for 4 weeks and decrease as appropriate.
11. Complete coding audit for all new procedures/services i.e. Transitional Care Management (TCM), Medicare Annual Wellness, Chronic Care Management (CCM), New surgical services, New office procedures.
12. Review/ audit records and prepares finding reports for Billing, Coding, and Auditing Task Force Committee.
13. Maintains strict confidentiality in accordance with HIPAA regulations.
14. Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
15. Embodies the principles of the corporate Mission Statement and Philosophy at all times.
16. Complies with departmental and company-wide policies and procedures.
17. Demonstrates knowledge of and supports hospital mission, vision, value statement, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.
18. Other duties as assigned.

JOB SPECIFICATIONS

EDUCATION:

1. Associates Degree in related field preferred. Certified Professional Coder (CPC) required.
2. Certified Documentation Expert-Outpatient (CDEO) certification examinationrequired or must obtain within one year of hire.
3. EXPERIENCE:
4. Minimum of three years coding and billing experience required. Minimum five years medical office experience. Minimum three years’ experience with an EMR system.
5. Clinical Documentation Improvement (CDI) experience preferred.
6. Must demonstrate knowledge of pathophysiology, coding and billing guidelines, and quality measures.
7. Understanding of new payment models MACRA and MIPS.
8. Knowledge of meaningful use requirements.
9. ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS
10. Able to travel independently throughout all MMA providers offices (including crowded or confined areas).
11. Require travel to medical offices across an assigned geography as necessary. Travel will range from 50% to 75% each month dependent upon audit and education schedules.
12. Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).
13. Must be able to sit or stand for long periods of time.
14. At minimum, 75% of time spent on the job will require standing or ambulating.
15. ESSENTIAL MENTAL ABILITIES
16. Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
17. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.
18. Ability to work in a stressful environment due to time constraints and handle difficult and sensitive situations tactfully.
19. Ability to follow instructions to learn work routines and problem solving.
20. Must be self-motivated with the ability to work independently.
21. ESSENTIAL TECHNICAL ABILITIES
22. Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.
23. Motor skills required to page through hard copy and computerized records.
24. ESSENTIAL SENSORY REQUIREMENTS
25. Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
26. Able to hear for work-related purposes.
27. Ability to communicate through written and verbal communications receptively, expressively, and with professionalism.

INTERPERSONAL SKILLS

1. Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.
2. Required to remain calm when adversity is encountered.
3. Open, honest, and tactful communication skills.
4. Ability to work as a team member in all activities.
5. Positive, cooperative and motivated attitude.
6. Ability to exercise helpfulness, patience and tact in communication skills daily.