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Job Description: The CDI Field Chart Review 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. Under the direction of the Senior Manager of RPM Education, the CDI Consultant will conduct concurrent reviews of outpatient medical records before 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.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Performs concurrent charge reviews for improving the overall completeness of clinical documentation.
o Assesses content of all clinical documentation prior to the patient being seen to identify all chronic conditions and comorbidities
o Collaborates with physician to identify and clarify missing, conflicting or nonspecific documentation related to diagnoses and procedures
o Promotes health record completion during the clinic visit, promoting patient safety and timely charge capture
• Acts as a resource for Providers and Coding staff
o Keeps abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and current CDI trends
o Effectively utilizes ICD-10, CPT, HCPCS, HEDIS, STARS and related materials to investigate coding issues and produce accurate results.
o Serves as an expert resource in reviewing all medical records in support of accurate documentation for all payer types to assure complete and accurate diagnosis, procedure capture and coding.
o Proactively coordinates and engages regular meetings with HIM Coding, Physician Champions and Leadership
o Leads and executes physician education strategies that result in improved clinical documentation and complete capture of diagnosis coding
o Contributes to the overall development and maintenance of the Medicare Advantage internal share point site and related reference materials
• Supports, monitors, and reports key performance indicators (KPIs) to Senior Management
o Monitors trends in the CDI process and develops and implements action plans to maximize the program.
o Develops and implements CDI strategies, provides analysis and makes recommendation for process improvement.
o Collaborate with staff within other functional areas (i.e. risk adjusted coding Physician Champions, Compliance Director, Coders)
o Develops monitoring tools to track progress of CDI program such as identification of cases with CDI opportunities, HCC recapture rate, etc.
• Maintains expert knowledge of CDI and ICD-10 Coding
o Keeps abreast of current changes in coding and reimbursement requirements for government programs and other third party payers.
o Reviews 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.
o Actively participates in meetings and/or seminars and disseminates the information to peers to enhance the knowledge and skills of the department.
o Other duties as assigned.
KNOWLEDGE SKILLS AND ABILITIES:
• Strong working knowledge of CMS guidelines, physician coding rules and guidelines
• Ability to interpret, analyze and abstract data/documentation
• Excellent verbal and written communication skills
• Strong team player with the ability to work under minimal supervision
• Ability to travel (75%)
• Excellent prioritization and organizational skills
• Takes initiative and has positive attitude
• Ability to work in a continuously changing environment, flexible
• Customer Service - interacts positively with all internal and external customers and takes immediate action to meet customer needs.
• Interpersonal/Communication/Relationships - builds effective working relationships and treats others with respect.
• Information Management - accesses, uses and presents information as relevant to position; demonstrates knowledge of HIPAA privacy and security rules and uses medical information as appropriate to position.
• Initiates collaboration with others outside of department as needed
• Demonstrates commitment to the principles and ethics of the organization
EDUCATION and/or CERTIFICATION/LICENSURE:
• Must have specific knowledge of CMS compliance guidelines, diagnostic and procedural terminology, ICD-10 and CPT/HCPCS coding systems, and billing compliance rules.
• Bachelor degree preferred
• RHIT, RHIA, CPC,CPMA, CRC,
• Certified Medical Coder, must have AAPC or AHIMA certification at a minimum
• Computer skills, including Microsoft Office suite of products
• Experience in multi-specialty physician coding is highly preferred
• Minimum of 3 to 5 years of clinical experience
• Minimum 3-5 years HEDIS/STARS experience
• Minimum 2 years experience at a health plan
• Must have Medicare Risk Adjustment coding experience
Comments for Suppliers: This position is for candidates that reside in the south Florida area and are willing to travel to individual provider offices in the south Florida region on a daily basis.
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