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Job Summary
The Clinical Documentation Integrity (CDI) Educator/DRG Auditor role involves reviewing inpatient medical records to identify documentation opportunities to accurately represent the severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics. Monitors internal key indicator metrics associated with CDI as it related to the revenue cycle and quality outcomes. Strategically audits cases in regard to Denial Prevention, Quality comorbidities, Risk Adjustment related data audits, and Quality Assurance audits. Facilitates improvement in overall quality, completeness, and accuracy of the medical record documentation through extensive audit investigation and data analysis. Based on findings from audits, the CDI Educator/DRG Auditor will provide system wide education and training to CDI team, Coding team, medical providers, and other healthcare teams on effective and compliant clinical documentation. The education is to be provided both in formal and informal settings, on an individual and group basis. The education tools to be used should include, but are not limited to, power point presentations, newsletters, and documentation tip sheets. The educator will work closely with both CDI and Coding leadership to identify educational opportunities for all members of the healthcare team responsible for medical record documentation. Acts as consultant and educator to providers, CDI, and coding staff relative to clinical documentation and coding. Assists with denial management as it relates to documentation. Assists with audit findings from third-party vendors to identify areas of opportunities. Demonstrates proficiency on ICD10-CM & PCS and respective coding guidelines & regulations for coding and reporting. Matter expert of key CDI hospital quality metrics (PSI, HACs, Vizient and Elixhauser Comorbidities, etc.) and Inpatient Prospective Payment System (IPPS) documentation requirements for proper APR & MS DRGs assignment. Auditor functions at a higher level by leading and supporting the CDI team; and by active participation in physician/clinical staff engagement and education. Communication skills, both verbal and written will be necessary to facilitate teaching/training. Analytical skills necessary to assist CDI manager with data analysis and reporting.Accountabilities
Performs quantitative and qualitative reviews and analysis of health records and physician queries to ensure documentation is accurate, consistent, complete and assigned codes can be supported by documentation. - 15%
Utilizes critical thinking and expertise to conduct chart reviews based on DRGs and analyze audit results to identify gaps in documentation. Uses patterns/trends to provide training opportunities for both providers and CDI team.\u00A0 Assists with audit findings from third-party vendors to identify areas of opportunities. \u2013 15%
Mentors and educates CDI team to meet and maintain goals and expectations. Creates and provides large group educational sessions for CDI team, coding team, and providers. - 10%
Provides individual education and feedback to team members based on DRG audit findings (including but not limited to opportunities related to\u00A0 improvement in chart reviews, coding practices, and query writing). Reports findings and recommendations to CDI program leadership to assist with team member audits, coaching, and/or action plans when improved opportunities are identified. \u2013 10%
Collaborates with CDI program leadership to plan, develop, and implement clinical documentation education programs for CDI specialists, coders, and providers. Reports provider specific documentation issues and opportunities to CDI Supervisors/leadership and assists with physician education. \u2013 10%
Assists the CDI manager with the preparation of data and reports to evaluate the effectiveness of department.\u00A0 Utilizes analysis of a variety of data sets and audits to assist in identifying gaps, root causes and solutions for CDiSs and physician leadership.\u00A0 Assists with denial management as it relates to documentation and DRG downgrades. - 10%
Participates in the interview process and evaluation of CDIS candidates, assisting CDI Manager in identifying the best candidates for hire. Coordinates with CDI Supervisors/leadership to develop, implement, and coordinate a strong new CDI orientation program including competency standards. - 10%
Stays current on changes in documentation requirements, coding guideline changes, CDI related literature, best practices, and other industry official guidance. - 10%
Act as a resource and subject matter expert to all members of the health care team with regards to optimal clinical documentation requirements.\u00A0 Promote and assist the CDI team with achieving additional certification and degrees where possible. - 10%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
Bachelor's degree - Nursing, Health Information Management, or related healthcare field
5 years - Adult medical/surgical/critical care/ER/PACU nursing, Clinical documentation improvement, Coding or related field
In Lieu Of
In Lieu of the education and experience requirements noted above, the following combination of education, training and/or experience will be considered an equivalent substitution: MD/DO/PA/NP.
Required Certifications, Registrations, Licenses
Any of the following: RN/RHIA/RHIT/CCS/CIC as well as CCDS/CDIP.
Knowledge, Skills or Abilities
3-5 years CDI experience
Experience in formulating and presenting formal education to physicians and clinical team.
Excellent observation, analytical/critical thinking and problem solving skills. Excellent oral and written communication skills.
Proficiency in comprehension of clinical disease process and treatment and regulatory documentation requirements.
Basic computer skills
Knowledge of office equipment (fax/copier)
Proficient computer skills (word processing, spreadsheets, database, PowerPoint)
Data entry
Mathematical skills
Work Shift
Day (United States of America)Location
CorporateFacility
7001 CorporateDepartment
70017540 Clinical Documentation IntegrityShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Job Summary
The Clinical Documentation Integrity (CDI) Educator/DRG Auditor role involves reviewing inpatient medical records to identify documentation opportunities to accurately represent the severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics. Monitors internal key indicator metrics associated with CDI as it related to the revenue cycle and quality outcomes. Strategically audits cases in regard to Denial Prevention, Quality comorbidities, Risk Adjustment related data audits, and Quality Assurance audits. Facilitates improvement in overall quality, completeness, and accuracy of the medical record documentation through extensive audit investigation and data analysis. Based on findings from audits, the CDI Educator/DRG Auditor will provide system wide education and training to CDI team, Coding team, medical providers, and other healthcare teams on effective and compliant clinical documentation. The education is to be provided both in formal and informal settings, on an individual and group basis. The education tools to be used should include, but are not limited to, power point presentations, newsletters, and documentation tip sheets. The educator will work closely with both CDI and Coding leadership to identify educational opportunities for all members of the healthcare team responsible for medical record documentation. Acts as consultant and educator to providers, CDI, and coding staff relative to clinical documentation and coding. Assists with denial management as it relates to documentation. Assists with audit findings from third-party vendors to identify areas of opportunities. Demonstrates proficiency on ICD10-CM & PCS and respective coding guidelines & regulations for coding and reporting. Matter expert of key CDI hospital quality metrics (PSI, HACs, Vizient and Elixhauser Comorbidities, etc.) and Inpatient Prospective Payment System (IPPS) documentation requirements for proper APR & MS DRGs assignment. Auditor functions at a higher level by leading and supporting the CDI team; and by active participation in physician/clinical staff engagement and education. Communication skills, both verbal and written will be necessary to facilitate teaching/training. Analytical skills necessary to assist CDI manager with data analysis and reporting.Accountabilities
Performs quantitative and qualitative reviews and analysis of health records and physician queries to ensure documentation is accurate, consistent, complete and assigned codes can be supported by documentation. - 15%
Utilizes critical thinking and expertise to conduct chart reviews based on DRGs and analyze audit results to identify gaps in documentation. Uses patterns/trends to provide training opportunities for both providers and CDI team.\u00A0 Assists with audit findings from third-party vendors to identify areas of opportunities. \u2013 15%
Mentors and educates CDI team to meet and maintain goals and expectations. Creates and provides large group educational sessions for CDI team, coding team, and providers. - 10%
Provides individual education and feedback to team members based on DRG audit findings (including but not limited to opportunities related to\u00A0 improvement in chart reviews, coding practices, and query writing). Reports findings and recommendations to CDI program leadership to assist with team member audits, coaching, and/or action plans when improved opportunities are identified. \u2013 10%
Collaborates with CDI program leadership to plan, develop, and implement clinical documentation education programs for CDI specialists, coders, and providers. Reports provider specific documentation issues and opportunities to CDI Supervisors/leadership and assists with physician education. \u2013 10%
Assists the CDI manager with the preparation of data and reports to evaluate the effectiveness of department.\u00A0 Utilizes analysis of a variety of data sets and audits to assist in identifying gaps, root causes and solutions for CDiSs and physician leadership.\u00A0 Assists with denial management as it relates to documentation and DRG downgrades. - 10%
Participates in the interview process and evaluation of CDIS candidates, assisting CDI Manager in identifying the best candidates for hire. Coordinates with CDI Supervisors/leadership to develop, implement, and coordinate a strong new CDI orientation program including competency standards. - 10%
Stays current on changes in documentation requirements, coding guideline changes, CDI related literature, best practices, and other industry official guidance. - 10%
Act as a resource and subject matter expert to all members of the health care team with regards to optimal clinical documentation requirements.\u00A0 Promote and assist the CDI team with achieving additional certification and degrees where possible. - 10%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
Bachelor's degree - Nursing, Health Information Management, or related healthcare field
5 years - Adult medical/surgical/critical care/ER/PACU nursing, Clinical documentation improvement, Coding or related field
In Lieu Of
In Lieu of the education and experience requirements noted above, the following combination of education, training and/or experience will be considered an equivalent substitution: MD/DO/PA/NP.
Required Certifications, Registrations, Licenses
Any of the following: RN/RHIA/RHIT/CCS/CIC as well as CCDS/CDIP.
Knowledge, Skills or Abilities
3-5 years CDI experience
Experience in formulating and presenting formal education to physicians and clinical team.
Excellent observation, analytical/critical thinking and problem solving skills. Excellent oral and written communication skills.
Proficiency in comprehension of clinical disease process and treatment and regulatory documentation requirements.
Basic computer skills
Knowledge of office equipment (fax/copier)
Proficient computer skills (word processing, spreadsheets, database, PowerPoint)
Data entry
Mathematical skills
Work Shift
Day (United States of America)Location
CorporateFacility
7001 CorporateDepartment
70017540 Clinical Documentation IntegrityShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.