Coding-CDI Quality RN Coordinator - Full Time - Remote

LCMC Health

1d•Remote

About The Position

Your job is more than a job GENERAL DUTIES: Quality, Patient Safety, and Outcomes Focus Serves as a key partner to the Quality Department in the identification, clinical validation, prevention, and mitigation of Hospital-Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) through comprehensive review of inpatient medical records. Conducts clinical validation reviews of quality-impacting diagnoses and conditions, including but not limited to sepsis, acute respiratory failure, acute kidney injury (AKI), malnutrition, HACs, and PSIs. Validates coded diagnoses against clinical indicators, laboratory trends, diagnostic imaging, treatment plans, orders, and provider documentation to ensure clinical accuracy. Reviews records associated with potential PSIs and HACs to validate the appropriateness of triggers, identify documentation gaps, and ensure accurate attribution under AHRQ technical specifications. Evaluates whether PSI and HAC conditions were clinically present, present on admission, preventable, or appropriately documented, and identifies discrepancies impacting quality outcomes, mortality risk models, and PSI/HAC assignment. Identifies and reviews readmission-related variable diagnoses and codes that impact readmission risk adjustment, ensuring documentation accurately reflects patient complexity and comorbid conditions influencing post-discharge outcomes. Participates in Hospital Acquired Management Risk Strategies (HAMRS) Meeting reviews, mortality reviews, and readmission review workflows as a CDI subject-matter expert, including second-level reviews and escalation processes as needed. Documentation Integrity and Clinical Validation Performs comprehensive concurrent and retrospective reviews of inpatient medical records to identify clinically valid diagnoses and procedures and ensure documentation accurately reflects the patient’s condition, severity, and services rendered. Initiates compliant clarification queries when documentation is incomplete, inconsistent, conflicting, or clinically unsupported, with a focus on quality-driven diagnoses and outcomes. Ensures documentation supports accurate capture of Severity of Illness (SOI) and Risk of Mortality (ROM) and aligns with regulatory requirements and evidence-based clinical criteria (e.g., Sepsis-3, KDIGO, ASPEN, AHRQ specifications). Performs second-level reviews related to quality-driven documentation queries, clinical validation denials, and appeal cases in collaboration with Physician Advisors and Quality leadership. Quality Reporting, Coding Support, and Regulatory Alignment Collaborates with Quality, Coding, and HIM teams to validate cases impacting publicly reported quality metrics, including PSI-90, HAC Reduction Program measures, mortality, and readmissions. Reviews cases identified through quality audits, PSI/HAC reports, denial data, and analytic tools to ensure documentation integrity and accurate reporting. Supports accurate ICD-10-CM/PCS coding by collaborating with Coding, Quality, and Physician Advisor teams to resolve documentation and clinical validation issues. Denial Management and Data Review Provides clinical support for payer denials, clinical validation appeals, RAC/MAC audits, and other external reviews related to documentation accuracy and quality measures. Tracks and analyzes trends in documentation gaps, denial patterns, PSI/HAC vulnerabilities, and readmission risk drivers to inform improvement initiatives. Provider Engagement, Education, and Collaboration Develops and delivers targeted education for providers and interdisciplinary teams on clinical validation standards, high-impact diagnoses, and quality-sensitive documentation practices. Partners with Physician Advisors to support documentation improvement, query compliance, and provider engagement strategies. Works collaboratively with Quality, CDI, Coding, Infection Prevention, Case Management, and other stakeholders to ensure accurate clinical representation and alignment with organizational quality priorities. Participates in multidisciplinary rounds, huddles, or meetings as needed to support real-time documentation and quality improvement efforts. Contributes to continuous improvement initiatives focused on patient safety, quality outcomes, regulatory compliance, and data integrity.

Requirements

BSN- bachelor’s degree of Nursing
Requires minimum 10 years bedside nursing experience, additional 5 years’ combined experience in Med/Surg/ICU/CCU
5 years’ experience as a CDI specialist in an Academic Medical Center, preferably working with physicians and quality department nurses to improve physician documentation.
Required: American Heart Association Basic Life Support/CPR
Active Licensed Registered Nurse
Certification as a CCDS through ACDIS is required. LCMC will allow up to one year from the date of hire to earn this credential.
Knowledge as it relates to, but not limited to, electronic health record, health information systems and healthcare applications and their effects on Coding practices today and in the future.
High ethical standards.
Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPS, MS-DRG, APR-DRG and APC coding guidelines.
Knowledge related to risk due to patient safety indicators (PSIs), Hospital Acquired Conditions (HACs) and other ongoing core measures
Extensive knowledge of hospitals and professional coding include provider-based billing.
Experience with concurrent reviews.
Knowledge of medical terminology, classifications systems and vocabulary.
Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
Experience in assisting and identifying learning needs as well as providing education and training designed to support a learning organization.
Strong analytical abilities and problem-solving skills.
Excellent oral, written and interpersonal communication skills.
Ability to organize and set priorities to ensure objectives are met in a timely manner.
Ability to adapt to change and handle challenges proactively and with pose.
Ability to effectively collaborate with physicians and managerial staff at all levels.

Nice To Haves

Preferred certification: Certified Clinical Documentation Specialist (CCDS per ACDIS)

Responsibilities

Serves as a key partner to the Quality Department in the identification, clinical validation, prevention, and mitigation of Hospital-Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) through comprehensive review of inpatient medical records.
Conducts clinical validation reviews of quality-impacting diagnoses and conditions, including but not limited to sepsis, acute respiratory failure, acute kidney injury (AKI), malnutrition, HACs, and PSIs.
Validates coded diagnoses against clinical indicators, laboratory trends, diagnostic imaging, treatment plans, orders, and provider documentation to ensure clinical accuracy.
Reviews records associated with potential PSIs and HACs to validate the appropriateness of triggers, identify documentation gaps, and ensure accurate attribution under AHRQ technical specifications.
Evaluates whether PSI and HAC conditions were clinically present, present on admission, preventable, or appropriately documented, and identifies discrepancies impacting quality outcomes, mortality risk models, and PSI/HAC assignment.
Identifies and reviews readmission-related variable diagnoses and codes that impact readmission risk adjustment, ensuring documentation accurately reflects patient complexity and comorbid conditions influencing post-discharge outcomes.
Participates in Hospital Acquired Management Risk Strategies (HAMRS) Meeting reviews, mortality reviews, and readmission review workflows as a CDI subject-matter expert, including second-level reviews and escalation processes as needed.
Performs comprehensive concurrent and retrospective reviews of inpatient medical records to identify clinically valid diagnoses and procedures and ensure documentation accurately reflects the patient’s condition, severity, and services rendered.
Initiates compliant clarification queries when documentation is incomplete, inconsistent, conflicting, or clinically unsupported, with a focus on quality-driven diagnoses and outcomes.
Ensures documentation supports accurate capture of Severity of Illness (SOI) and Risk of Mortality (ROM) and aligns with regulatory requirements and evidence-based clinical criteria (e.g., Sepsis-3, KDIGO, ASPEN, AHRQ specifications).
Performs second-level reviews related to quality-driven documentation queries, clinical validation denials, and appeal cases in collaboration with Physician Advisors and Quality leadership.
Collaborates with Quality, Coding, and HIM teams to validate cases impacting publicly reported quality metrics, including PSI-90, HAC Reduction Program measures, mortality, and readmissions.
Reviews cases identified through quality audits, PSI/HAC reports, denial data, and analytic tools to ensure documentation integrity and accurate reporting.
Supports accurate ICD-10-CM/PCS coding by collaborating with Coding, Quality, and Physician Advisor teams to resolve documentation and clinical validation issues.
Provides clinical support for payer denials, clinical validation appeals, RAC/MAC audits, and other external reviews related to documentation accuracy and quality measures.
Tracks and analyzes trends in documentation gaps, denial patterns, PSI/HAC vulnerabilities, and readmission risk drivers to inform improvement initiatives.
Develops and delivers targeted education for providers and interdisciplinary teams on clinical validation standards, high-impact diagnoses, and quality-sensitive documentation practices.
Partners with Physician Advisors to support documentation improvement, query compliance, and provider engagement strategies.
Works collaboratively with Quality, CDI, Coding, Infection Prevention, Case Management, and other stakeholders to ensure accurate clinical representation and alignment with organizational quality priorities.
Participates in multidisciplinary rounds, huddles, or meetings as needed to support real-time documentation and quality improvement efforts.
Contributes to continuous improvement initiatives focused on patient safety, quality outcomes, regulatory compliance, and data integrity.