Executive Director of Clinical Documentation Improvement

Wellstar Health System • VIRTUAL-WI, WI

4d • Onsite

About The Position

The Executive Director of Clinical Documentation Improvement (CDI) possesses a high level of clinical proficiency necessary for the oversight of the CDI Program. Oversees strategies and planning to ensure an accurate reflection of the patient clinical picture in the medical record and downstream impact on accurate coding. Proven leadership to promote effective and efficient review of physician documentation to support the patient's level of care and appropriate assignment of DRGs, RAF Scores, and other financial and quality metrics, and develop action plans for improvement. The Executive Director of CDI must be able to create and sustain excellent relationships with executives, medical and clinical staff at the Wellstar Hospitals and the Wellstar Medical Group and affiliated physicians. Must have expertise in the areas of operations, coding, billing and quality/public reporting in acute care hospitals, medical groups, health plans and emerging payment systems. Collaborates with interdisciplinary teams including, but not limited to, executives, physicians, APPs, and the leadership for Quality, Revenue, Service Lines, Coding, Care Coordination, IT and Health Information Management. Collaborates extensively with other members of the health care team to provide data and solution development processes. The Executive Director of CDI creates a support structure within each medical staff department as well as Wellstar Medical Group for achieving clinical and operational excellence and expected deliverables of the Program in relation to Clinical Documentation Improvement efforts. Is involved in the direction and education of all phases of the Clinical Documentation process, planning and execution of strategic initiatives. Requires skill and leadership in leading the day-to-day operations of the Clinical Documentation Department team and the staffing and training needs to meet the expected requirements of the Program. Provides ongoing Clinical Documentation management program education for new staff, including new Clinical Documentation Specialists, physicians, nurses and allied health professionals. Tracks and trends program compliance. The Executive Director of CDI must have the ability to transform the work of the department as Wellstar grows and changes, aligning and directly impacting key strategic goals. Ability to evolve the CDI department in new, innovative, effective ways to continually improve and contribute to system goals and strategies. Ensures that Wellstar can demonstrate that it has appropriately and effectively accepted payments from governmental agencies which are based on clinical documentation (e.g., meaningful use payments, ACO payments, etc.) by establishing and overseeing auditing programs in these areas. Able to lead in a high visibility, high impact role alongside clinical and operational leaders.

Requirements

• Bachelors Health Information Management or Bachelors Nursing or Masters
• All certifications are required upon hire unless otherwise stated.
• Minimum 10 years of progressive healthcare experience with at least five (5) years of CDI, nursing or HIM leadership experience.
• Advanced clinical expertise and extensive knowledge of complex disease processes, clinical data analysis and reporting and acute care, medical group and health plan experience.
• Skill in identifying problems and recommending solutions.
• Skill in preparing and maintaining records and written reports.
• Skill in establishing and maintaining effective working relationships with physicians, hospital staff and vendors.
• Ability to interpret, adopt, and apply guidelines and procedures.
• Ability to analyze complex scenarios and apply critical thinking.
• Extensive knowledge of reimbursement systems.
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation and coding.

Nice To Haves

• Additional License(s) and Certification(s)

Responsibilities

• Based on strategic initiatives and WellStar goals develops and manages the Documentation Improvement Department initiatives.
• Oversees the daily operations of the acute care and WellStar Medical Group CDI departments.
• Ensures successful execution of strategies that contribute to system goals: a) Proficient in translating complex systems into key initiatives and executing with effective change management and stakeholder engagement. b) Must possess skills required to run a fiscally responsible program while ensuring constant improvement and demonstrating return on investment, value added from program c) Extensive knowledge of treatment and documentation methodologies, electronic medical record (EMR) and other technology capabilities, data collection and reporting techniques, and coding and classification systems. d) Maintain expertise in various regulatory, guideline and quality criteria and requirements related to quality, coding, billing and clinical documentation e) Demonstrated ability to provide leadership and direction to Documentation Department Staff and coding specialists with relation to Clinical Documentation issues and establishes programs for the team to ensure compliance with productivity & quality standards. f) Knowledge of insurance regulations and Medicare and Medicaid guidelines, ACO and other payment models, Vizient and other quality algorithms and criteria. g) Develop and manage to departmental budgets h) Ensure that the key metrics related to documentation improvement such as CMI are on target and explainable.
• Identify Clinical Documentation opportunities to collaborate, educate, and improve in order to achieve strategic goals.
• Take the lead on communication and documentation improvement initiatives with physicians, nurses, coding, quality, billing and other members of the health care team, working independently to resolve such issues. a) Lead performance improvement initiatives in the areas of opportunity to improve documentation tools and clinical data b) Subject Matter Expert in data analysis and clinical documentation to help teams determine root causes c) Determines trends and helps create action plans based on internal and external data such as PEPPER, Vizient, financial reports, etc. d) Internal Coding Audit Data e) Coding Educator Data f) Coding Quality Manager Data
• Develop & Oversee Audit Programs & Ensure the Accuracy of External Reporting Through Implementing Data Quality Programs for: a) Risk Adjustment Factor-Based Payments (i.e., shared savings) b) ACO Payments c) Vizient, Leapfrog d) Accurate payment with all other payors within scope
• Coding/Data Quality Education a) Oversee coding and data quality educational program based on the action plans and identified needs. Working with a broader audience, med staff committees, service lines, Business Intelligence, etc.
• Performs other duties as assigned
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Benefits

• Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems.
• Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top-notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive