CDI Manager

KPC GLOBAL MEDICAL CENTERS•Santa Ana, CA

About The Position

The Manager Clinical Documentation Improvement (CDI) is responsible for managing CDI specialists and the CDI program, including recruiting, hiring, training, mentoring, and performance management. The position oversees the structure, processes, and accountability of documentation improvement and health data collection to support accurate provider documentation and appropriate reporting and reimbursement of healthcare services. The manager develops and implements communication and education programs for CDI operations, assists with DRG denial responses and OSHPD reporting for OC hospitals, and has primary responsibility for DRG optimization. The role also supports medical staff in improving documentation quality, serves as a reimbursement coding mentor, and participates in chart review projects as assigned. The position establishes policies and changes to improve reimbursement coding outcomes; evaluates coding personnel and processes; reviews coding and reporting; and instructs and manages Coding and CDI personnel. It reviews medical records, supports accurate coding and abstraction, consults with medical staff to clarify diagnoses or procedures, and serves as a liaison to improve documentation. The role also monitors coding status and uncoded records, mentors staff, maintains confidentiality, and completes work according to productivity and quality standards.

Requirements

At least three years of coding systems experience in a hospital setting; the posting states “Minimum five (3) years.”
Two years of supervisory experience.
Certified Coding Specialist (C.C.S.) certification or license required.
Knowledge of compliance and regulatory requirements, information systems, and Health Information Systems.
Knowledge of CPT, DRG, APC, and ICD-10-CM and ICD-10-PCS coding guidelines.
Successful completion of college-level courses in anatomy, physiology, medical terminology, and coding.
Experience managing Clinical Documentation Improvement Specialists and understanding their relationship to clinical documentation.
Ability to meet the physical requirements: prolonged sitting and standing, arm and hand dexterity, close and distant vision, color perception, hearing, and lifting or moving up to 25 pounds.

Nice To Haves

Successful completion of or current enrollment in a program for certification as a Certified Coding Specialist (C.C.S.), Registered Health Information Technician (R.H.I.T.), or Registered Health Information Administrator (R.H.I.A.).
Experience using an encoder software product for code assignment in an acute care setting.
Experience with the McKesson Intelligent Coding (Charging) application.

Responsibilities

Manage CDI specialists and the CDI program, including recruiting, hiring, training, mentoring, and performance management.
Establish policies and implement changes to enhance reimbursement coding outcomes.
Evaluate the effectiveness of coding personnel and processes, and review and correct reimbursement codes as applied to financial reports.
Provide instruction and management for Coding and CDI personnel.
Maintain patient confidentiality and disclose only the minimum information necessary to those with a right and need to know.
Review available medical record documentation and accurately assign principal and secondary diagnoses and procedures.
Apply CPT conventions and AMA guidelines for surgical and diagnostic procedure coding, and follow AHA Coding Clinic and hospital coding guidelines.
Abstract patient data accurately and complete required elements in the electronic information system.
Follow department policy and UHDDS abstracting guidelines, supporting positive OSHPD error-report outcomes.
Ensure pertinent documentation is available for final coding and abstracting, and appropriately address discrepancies in medical records and transcribed reports.
Consult with medical staff to clarify diagnoses and procedures; formulate clear, concise queries that support timely responses, complete documentation, and accurate coding.
Educate and provide feedback to medical staff to improve medical-record documentation quality.
Prioritize records for coding, including STAT requests, and consistently update coding status in the abstract module.
Monitor uncoded records and resolve issues to ensure timely abstracting and coding.
Serve as a role model and mentor to support the professional development of coding staff.
Communicate clearly and concisely with requestors and provide effective assistance.
Complete assigned duties in accordance with productivity requirements and quality standards, while maintaining a positive attitude.
Report equipment malfunctions and arrange service as needed.
Inventory and order supplies to maintain adequate stock.
Participate in continuing education and maintain CEUs required for certification or department policy.
Maintain current AHIMA certification.
Perform other duties as assigned or required.
Assist with DRG denial responses and OSHPD reporting for OC hospitals.
Lead DRG optimization and support medical staff in improving documentation quality.
Participate in chart review projects as assigned.