Clinical Documentation Improvement (CDI) Specialist I
We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.
The CDI Specialist Level I is responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate if clinical documentation is reflective of medical necessity, quality of care outcomes and reimbursement compliance for acute care services provided. Works closely with the medical staff to facilitate appropriate clinical documentation of patient care. Other responsibilities include conducting initial and extended-stay concurrent reviews on all selected admissions and documenting findings.
Job Responsibilities/Duties
Reviews inpatient medical records, meeting all department productivity goals, for identified payor populations as directed on admission and throughout hospitalization and identifies potential gaps in physician documentation. Ensures that clinical documentation reflects the level of service rendered to patients in a complete, accurate and compliant manner.
Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process, meeting department productivity goals. Follows up with the physicians to get resolution of all queries prior to patient's discharge to ensure accurate quality data and appropriate reimbursement whilst maintaining up to date DRG. Assists coders in follow-up on queries and clarifications to physicians done retrospectively post patient discharge.
Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through comprehensive auditing and evaluation of the medical record. Collects and analyzes data to provide reports and make recommendations. Works collaboratively with Performance Improvement Department to improve clinical documentation for compliance in quality of care measures.
Performs the duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and all regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
Reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician. Follow-up in improving clinical documentation to reduce such denials. Works collaboratively with health information management coding staff, physicians and financial services to resolve payment denials and documentation issues.
Regularly participates in scheduled case management meetings and actively exchanges information pertaining to clinical documentation, plan of care affecting coding.
Qualifications
Minimum Education: None.
Minimum Experience: Ability to multitask and maintain a work pace appropriate to workload. Must demonstrate customer service skills appropriate to the job. Excellent written and verbal communication skills in English. Ability to effectively communicate with physicians in a clear and concise manner. Computer literacy and proficiency. Experience in US acute care hospital setting preferred. Previous experience working as CDI preferred.
Req. Certification/Licensure: Medical Graduate, Physician Assistant or Registered Nurse (Current CA License) required. Hospital Fire and Life Safety Card (Los Angeles City Employees only) required.
Employee Value Proposition
Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:
Company 401K
Medical, dental, vision insurance
Paid time-off
Life insurance
How to Apply
To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.
EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm
Keywords: Clinical Doc Specialist, Doc Specialist, CCS, CCDS, Registered Nurse, RN, Entry Level, Medical Record Keeping.
