Associate Director of CDI Education and Quality

Emory Healthcare•Atlanta, GA

About The Position

JOB DESCRIPTION: The Associate Director of CDI for Emory Hospitals provide leadership for clinical documentation operations for Emory Healthcare, and working under the leadership direction of the CDI director. Leaders in this role will plan, direct, manage, coordinate and monitor all aspects of the Clinical Documentation Program. The main objective of the program is to facilitate appropriate provider documentation of care delivery to accurately reflect patient severity of illness and risk of mortality, quality of care, quality outcomes and reimbursement, with these leaders providing local support to meet this objective. The Emory Hospitals include Emory Johns Creek Hospital, Emory Saint Josephs Hospital, Emory University Hospital, Emory University Hospital Midtown, Emory University Orthopaedic and Spine Hospital, Emory Hillandale Hospital and Emory Decatur Hospital. This responsibility includes participation in strategy development, education, implementation planning, execution, and monitoring of progress towards department and organizational goals. Develops and maintains strong working relationships with other leaders in the CDI and HIM Departments, CDI Medical Directors and other Medical Staff leaders, and CFO's and other facility and EHC leaders. Monitors daily performance of each CDS to ensure timeliness of daily reviews, reconciliations and query follow-up. Responsible for analyzing the facility's monthly Key Performance Indicators such as the facility's CMI, top 25 DRGS, SOI and ROM, Vizient LOS and Mortality O/E reporting any variances and actions necessary to improve the facility's CDI performance, ensures work lists are up to date resolving older cases requiring any further actions by management to resolve. Utilizes 3M 360 and EPIC for data analytics and outcomes based performance measures. Works in conjunction with all associate directors to assist when CDI staff educational needs are identified. Maintains a working knowledge of CMS and other payers with regards to Coding guidelines. Communicates and interacts with physicians and clinical staff at the facility level via informal verbal communication, the use of written communication tools, and formal educational presentations. With the assistance from corporate management utilizes key reports such as facility's physician query response report, and observations to provide recommendations to improve the overall quality and completeness of the facility's clinical documentation. Establishes cooperative and multidisciplinary working relationship with facility leadership (CFO), physicians, coding staff and other health team members. Acts as a resource to the CDI department and health team members related to optimal documentation, educational needs and successful problem resolution. Familiarity with MS-DRG/APR-DRG's and Inpatient Prospective Payment System (IPPS), including new CMS guidelines of key elements including clinical documentation of what constitutes an inpatient admission. Along with familiarity and the ability to effectively communicate the use various coding systems and Official Coding Guidelines. Performs concurrent and retrospective reviews of the medical record for auditing performance of CDS staff, utilizing evidence-based knowledge, protocols and criteria. Facilitates modifications to support clinical documentation of health team members to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a focus on physician documentation, inpatients and DRG payers. Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes. Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded in the patient's chart. Develops, implements and maintains formal and informal educational programs, including creating the CDI orientation program, related to documentation improvement opportunities, coding and reimbursement issues, as well as performance improvement methodologies for internal customers and physicians. Analyzes and compiles accurate and complete data for statistical reporting and educational presentations, as needed. Supports DRG optimization through reconciliation and validation, pre-bill review and other tasks as needed. Analyzes, summarizes and documents outcomes of documentation improvement process for re-evaluation of ongoing program revisions. Participates as a member of work groups related to clinical documentation, utilization and compliance, if required. Performs other duties as needed.

Requirements

Graduate of an accredited school of Nursing, or United States or International School of Medicine Education
Must have at least 5 years in healthcare related field with strong clinical expertise and acumen
For RNs, candidates must have an active license
All nurses employed in roles requiring an unencumbered nursing license must have a valid, active license or temporary permit approved by the Georgia Licensing Board
CCDS or CDIP required
Familiarity with MS-DRG/APR-DRG's and Inpatient Prospective Payment System (IPPS), including new CMS guidelines of key elements including clinical documentation of what constitutes an inpatient admission
Familiarity and the ability to effectively communicate the use various coding systems and Official Coding Guidelines

Nice To Haves

CCS preferred

Responsibilities

Plan, direct, manage, coordinate and monitor all aspects of the Clinical Documentation Program
Facilitate appropriate provider documentation of care delivery to accurately reflect patient severity of illness and risk of mortality, quality of care, quality outcomes and reimbursement
Participate in strategy development, education, implementation planning, execution, and monitoring of progress towards department and organizational goals
Develop and maintain strong working relationships with other leaders in the CDI and HIM Departments, CDI Medical Directors and other Medical Staff leaders, and CFO's and other facility and EHC leaders
Monitor daily performance of each CDS to ensure timeliness of daily reviews, reconciliations and query follow-up
Analyze the facility's monthly Key Performance Indicators such as the facility's CMI, top 25 DRGS, SOI and ROM, Vizient LOS and Mortality O/E reporting any variances and actions necessary to improve the facility's CDI performance, ensures work lists are up to date resolving older cases requiring any further actions by management to resolve
Utilize 3M 360 and EPIC for data analytics and outcomes based performance measures
Work in conjunction with all associate directors to assist when CDI staff educational needs are identified
Maintain a working knowledge of CMS and other payers with regards to Coding guidelines
Communicate and interact with physicians and clinical staff at the facility level via informal verbal communication, the use of written communication tools, and formal educational presentations
Utilize key reports such as facility's physician query response report, and observations to provide recommendations to improve the overall quality and completeness of the facility's clinical documentation
Establish cooperative and multidisciplinary working relationship with facility leadership (CFO), physicians, coding staff and other health team members
Act as a resource to the CDI department and health team members related to optimal documentation, educational needs and successful problem resolution
Perform concurrent and retrospective reviews of the medical record for auditing performance of CDS staff, utilizing evidence-based knowledge, protocols and criteria
Facilitate modifications to support clinical documentation of health team members to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a focus on physician documentation, inpatients and DRG payers
Ensure the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes
Conduct follow-up reviews of clinical documentation to ensure points of clarification have been recorded in the patient's chart
Develop, implement and maintain formal and informal educational programs, including creating the CDI orientation program, related to documentation improvement opportunities, coding and reimbursement issues, as well as performance improvement methodologies for internal customers and physicians
Analyze and compile accurate and complete data for statistical reporting and educational presentations, as needed
Support DRG optimization through reconciliation and validation, pre-bill review and other tasks as needed
Analyze, summarize and document outcomes of documentation improvement process for re-evaluation of ongoing program revisions
Participate as a member of work groups related to clinical documentation, utilization and compliance, if required
Perform other duties as needed