CDI Quality Analyst

UIOWA•Iowa City, IA

15h•Hybrid

About The Position

The Clinical Documentation Improvement (CDI) program at UI Health Care has an opening for a full-time CDI Quality Analyst. The primary purpose of Clinical Documentation Improvement (CDI) is concurrent review of the medical record to increase the accuracy, clarity, and specificity of provider documentation. The CDI Quality Analyst bridges the gap between the providers and hospital coders to clarify at-risk documentation to ensure accurate claim submission. CDI quality chart reviews include: New acute inpatient admissions to the facility. Initial and Concurrent reviews at risk charts with opportunities for improved quality documentation. Retrospective reviews for query identification, documentation clarification, denials, or quality measures. Completes quality reviews focused on CDI quality elements, such as Mortality, Hospital Acquired Conditions (HAC), and other publicly reported patient quality or safety metrics. When provider documentation is illegible, incomplete, imprecise, inconsistent, conflicting, or unreliable, the CDI Quality Analyst is expected to communicate (i.e., query) with the provider to obtain the necessary information to clarify the medical record. The CDI Quality Analyst must hold a general proficiency within both the clinical and hospital coding skill sets. The CDI Quality Analyst provides the geometric mean length of stay (GMLOS) associated with the working DRG to identify the expected length of stay for acute inpatients.

Requirements

A Baccalaureate degree in Nursing or a master's degree in Nursing (MNHP or MSN) is required.
License to practice nursing in Iowa is required.
Two years of inpatient nursing experience in a medical-surgical, and/or ICU setting is required.
Recent work experience as a Clinical Documentation Specialist, CDI nurse, or healthcare quality professional with specific medical record review experience is required.
Must obtain CCDS (Certified Clinical Documentation Specialist) certification within 3 years of hire.
Professional written and verbal communication skills are required.
Demonstrates the ability to provide effective education in a variety of styles, including formal presentations.
Proficiency with computer software applications (i.e., Microsoft applications) is required.
Demonstrates excellent interpersonal skills with physicians, nursing staff, and interdisciplinary team members as demonstrated through written and verbal communication is required.
Demonstrated organizational, time management and problem-solving skills are required.

Responsibilities

Establishes effective and collaborative relationships with members of the hospital community to improve accuracy and completeness of acute inpatient documentation, especially with providers, Health Information Management coding staff, hospital administration, and other patient caregivers.
Demonstrates expertise of MS-DRGs, APR-DRGs, documentation opportunities, clinical documentation requirements, and inpatient quality/safety metrics.
Performs analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical validation, denials, HACs, PSIs and other quality related measures.
Assures appropriate action is taken within appeal time frames to address clinical denial.
Collaborates with Health Information Management for continued appeal processes.
Coordinates Clinical Denial appeal follow up.
Communicates identified denial trends and patterns to Clinical Documentation Improvement Leadership team.
Provides expert application of evidenced based medical necessity review criteria tool.
Utilizes multiple tools (MS, Tableau, Vizient, etc) to ensure accurate tracking and reporting of clinical denial data.
Works collaboratively to review, evaluate and improve the denial appeal process and establish a system-wide uniform process.
Collaborates with CDI/HIM Leadership and Physician Advisors in appropriately identified clinical denials requiring escalation.
Maintains clinical expertise and trends in healthcare, reimbursement methodologies and utilization management specialty areas by participating in professional organizations, seminars and educational programs, as requested.
Collaborates extensively with CDI/HIM partners to ensure all opportunities for quality improvement are identified and addressed on an ongoing basis.
Demonstrates expertise in use of Vizient risk variable tools and educates others for appropriate use of these tools.
Leads/Participates in CDI quality related committees.
Works hand in hand with CDI Leadership, Vizient analyst and CDI data analyst to establish a working reporting structure for all areas of specialty, including CDI nurses and members of the coding team.
Works hand in hand with physician advisors to ensure charts identified with patient safety indicators and hospital acquired conditions are reviewed concurrently when possible or retrospectively when necessary.
Reviews DRG mismatches and reports findings to the DRG variance committee each month.
Provides consistent education on clinical documentation opportunities, hospital coding and/or reimbursement issues, as well as performance improvement methodologies to all members of the hospital community.
Identifies opportunities for provider education to improve medical record documentation for severity, mortality of other risk adjustment variables.
Provides ongoing education as needed for all areas of specialty.
Reports findings and trends to hospital committees and initiatives as directed by leadership.
Conducts record reconciliation and communicates effectively with hospital coding staff to assign an appropriate working DRG.
Reviews all inpatient mortality cases with opportunity and shares findings regularly with leadership and the CDI team.
Works hand in hand with leadership and educator to ensure all opportunities identified are reported accurately each month.
Consistently attends and participates in meetings related to projects, initiatives, education related to quality driven CDI.
Provides ongoing and regular feedback to CDI team and leads regarding trends for all quality related measures impacted by CDI.
Assists with record review and vacation coverage, as needed.
Assists with coding notifications on an as needed basis for additional coverage.
Documents appropriately in the 3M© 360 Clinical Documentation Improvement system.
Demonstrates an understanding of the importance of capturing all potential secondary diagnosis for coding purposes.
Maintains thorough and current knowledge of clinical care and treatment of assigned patient populations to critically assess appropriateness of documentation.
Complies with departmental standards regarding attendance, documentation, departmental workflows, continuous quality improvement and statistics, departmental policies and procedures, and the Code of Ethics.
Effectively collaborates and respectfully communicates with fellow CDI team members, the hospital coding team, and quality-driven workgroups to ensure appropriate CDI practices and accurate application of coding/documentation principals.
Actively participates in office and/or intradepartmental committees.
Performs other projects or responsibilities as assigned.