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CDI Specialist

Job ID: 216764

Location: Albuquerque, New Mexico , US, 87106

Summary:

The CDI Coding Specialist uses clinical knowledge to serve as an advisor to providers and staff regarding complete and accurate documentation supporting services provided in the office based setting. The CDI Consultant will conduct concurrent reviews of outpatient medical records after the patient is seen as well as work with clinicians concurrently to guide and educate. This position collaborates with providers and coding teams to deliver education on documentation best practices that result in accurate, comprehensive medical record that reflects the diagnoses for the patient and supports patient care and correct reimbursement.

Project Details:

  • Perform retrospective chart reviews for improving the overall completeness of clinical documentation
  • Collaborate with physician to identify and clarify missing, conflicting or nonspecific documentation related to diagnoses and procedures
  • Communicate with clinicians to clarify documentation and query for specificity
  • Monitor verbal and written queries
  • Acts as a resource for Providers and Coding staff
  • Keep abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI current trends
  • Effectively utilizes ICD, CPT/HCPCS and related materials to investigate coding issues and produce accurate results
  • Serve as an expert resource in reviewing all medical records in support of accurate documentation for all payer types to assure complete and accurate diagnosis and procedure capture and coding
  • Proactively coordinate and engage regular meetings with HIM Coding, Physician champions and Leadership
  • Lead and execute physician education strategies that result in improved clinical documentation and complete capture of diagnosis coding
  • Contribute to the overall development and maintenance of the Medicare Advantage internal share point site and related reference materials
  • Supports monitor, and report key performance indicators (KPIs) to Senior Management
  • Monitor trends in the CDI process and develops and implement action plans to maximize the program
  • Develop and implement CDI strategies, provide analysis and make recommendation for process improvement
  • Collaborate with staff within other functional areas
  • Develop monitoring tools to track progress of CDI program such as identification of cases with CDI opportunities, HCC recapture rate, etc.
  • Maintain expert knowledge of CDI and ICD-10 Coding
  • Keep abreast of current changes in coding and reimbursement requirements for government programs and other third party payers
  • Review Medicare and Commercial payer publications on a frequent basis and develops coding education in a proactive fashion to add value to the overall quality of clinical documentation
  • Actively participate in meetings and/or seminars and disseminate the information to peers to enhance the knowledge and skills of the department
  • Other duties as assigned

Job Experience:

  • Minimum five (5) years of experience in either clinical nursing, case management, Inpatient Coding, Utilization Review, Physician Assistant or other clinical disciplines with either coding or CDI experience or an equivalent combination of these disciplines.
  • Bachelor's Degree in Nursing, Physician Assistant or other clinical heath care related field required.
  • Current license, certification or professional licensing in field of expertise required.
  • Familiarity with Windows based software programs and basic computer skills
  • Knowledge of health record content and sequence.
  • Knowledge of JCAHO requirements and federal and state guidelines applicable to health record completeness and patient privacy.
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