CDI Lead Specialist

Conifer Health Solutions • Frisco, TX

6d • Hybrid

About The Position

The CDI Lead Specialist educates members of the patient care team, including physicians, allied health practitioners, nursing, and case management, regarding documentation guidelines. This role assists with overseeing department workflow and metrics, and is responsible for educating and training department staff. The specialist reviews medical records to facilitate and obtain appropriate physician documentation for clinical conditions or procedures, supporting the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient.

Requirements

• Must display teamwork and commitment while performing daily duties.
• Must demonstrate initiative and discipline in time management and medical record review.
• CDI Subject Matter Expert with Advanced knowledge of Medicare Part A and familiar with Medicare Part B.
• Intermediate knowledge of disease pathophysiology and drug utilization.
• Intermediate knowledge of MS-DRG classification and reimbursement structures.
• Critical thinking, problem solving and deductive reasoning skills.
• Effective written and verbal communication skills.
• Knowledge of coding compliance and regulatory standards.
• Excellent organizational skills for initiation and maintenance of efficient workflow.
• Capacity to work independently in a virtual office setting or at facility setting if required to travel for assignment.
• Understand and communicate documentation strategies.
• Recognize opportunities for documentation improvement.
• Formulate clinically, compliant credible queries.
• Ability to comply with an auditing and monitoring program as a means to measure query process.
• Ability to apply coding conventions, official guidelines, and Coding Clinic advice to health record documentation.
• Must be able to resolve issues effectively and provide recommendations and solutions.
• Effectively explain processes and educate others.
• CDS SME with ongoing education with physicians and facility leaders.
• CDI facility representation for hospital and physician meetings.
• Local facility mentorship for CDI team support and effectiveness.
• CDI staff coverage as necessary.
• Gathering additional data as needed for supervisor, manager and director.
• Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

Nice To Haves

• Two (2) or more years’ experience in CDI.
• Graduate from a Nursing program, RN, BSN, Medical Doctor, Foreign Medical Doctor, and/or graduate of Health Information Management RHIT, RHIA preferred.
• Two (2) years’ experience with either HIM/Coding or Case Management experience.
• RN, Medical Doctor, Foreign Medical Doctor, or RHIT, RHIA, and/or CCS.
• CDIP or CCDS.

Responsibilities

• Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to evaluate documentation for principal diagnosis, pertinent secondary diagnoses, and procedures for accurate MS-DRG assignment, risk of mortality and severity of illness; and initiates a review in host system.
• Conducts follow-up reviews of patients every 1-3 days to support and update the working MS-DRG, as necessary.
• Formulates physician queries due to missing, unclear or conflicting documentation as necessary.
• Collaborates with providers, case managers, nursing staff and other ancillary staff to assist in resolving physician queries prior to discharge.
• Provides daily support/mentoring/training to new CDI hires as well as existing CDI staff.
• Provides assistance in managing escalated issues and special projects as needed to supervisors and managers.
• CDI staff coverage as necessary.
• Performs concurrent and/or retrospective CDI reviews as necessary.
• Provides CDI support/mentoring/training to Physicians and hospital leadership as necessary.
• Enters facility specific data to dashboards as necessary.
• Resolves problems, concerns and reports issues with Operations to Supervisor, Manager or Director.
• Assists with orientation of new CDI Staff.
• Completes yearly required learnshares.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD coding.
• Attends mandatory coding sessions on annual basis (IPPS and ICD updates) for inpatient coding.
• Quarterly review of AHA Coding Clinic.
• Attends Quarterly Coding Updates and all coding conference calls as well as any required CDI education.
• Conducts provider rounding, provides education, and communicates with providers on documentation and physician query opportunities as appropriate for follow up and resolution.
• Other duties as assigned.

Benefits

• Medical, dental, vision, disability, life, and business travel insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree