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Remote CDI Specialist

at Guidehouse in Montpelier, Vermont, United States

Job Description

Overview

Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures with a focus on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for future growth and success. The company has more than 10,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit: www.guidehouse.com.

Responsibilities

The Clinical Documentation Integrity (CDI) Specialist is responsible for conducting concurrent inpatient chart reviews on assigned service lines to ensure documentation is complete and accurate at the time of discharge to properly reflect the severity of illness and resources consumed for timely, accurate and compliant coding. Initiates queries in a professional, non-leading manner to clarify ambiguous or conflicting documentation, obtain specificity of diagnoses, and connect treatment performed to a diagnosis (if known). Performs coding, working DRG assignment and enters all review activity into tracking software daily. Perform any and all related job duties as assigned. Collaborates with physicians, extenders, other clinical staff, HIM and coding team members to follow the mission and maintain the integrity of the patient’s story through documentation. Improves the documentation through designated processed while remaining compliant with query processes and facility bylaws. Supports timely, accurate and complete documentation of clinical information used for measuring and reporting physician and facility outcomes. Job Description/Responsibilities:

+ Conducts daily, comprehensive, concurrent review of inpatient records on assigned service lines, to ensure complete and accurate physician and or clinician documentation is present at the time of discharge for accurate, timely, and compliant coding.

+ Reviews daily admissions to assigned unit, performs initial code assignment for a working DRG and completes CDI software data entry for initial and follow up case reviews per facility prioritization (and worksheet to include code and DRG assignment)

+ Updates “working DRG” in facility designated system for Case Management as documentation or physician query answer supports a change in the DRG assignment

+ Performs follow up reviews per facility prioritization and enters follow up review findings in CDI technology

+ Conducts DRG reconciliation with HIM coding team and follows escalation process for non-resolved accounts

+ nitiates compliant physician queries when documentation is confusing, ambiguous or missing and follows up with the MD to seek a timely response to query (utilizing the following AHIMA practice briefs as a guide: “Managing an Effective Query Process”, (October 2008 and “Guidance for Clinical Documentation Improvement Programs”, May 2010)

+ Ensures the query verbiage is in no way leading or suggestive in tone and is supported by the documentation in the record to include clinical indications and treatment provided

+ Possess a clear understanding of MS DRG guidelines and required documentation components for accurate code/DRG assignment

+ Keeps abreast of Coding Clinic updates, to include code changes, MCC and CC changes and/or changes in the DRG system to effectively educate CDI team and physician and clinical team members regarding changes

+ Baseline understanding of hospital acquired conditions HACs), patient safety indicators (PSIs) and mortality modeling

+ Understands and strives to maintain productivity and quality standards; reviews productivity and quality numbers monthly

+ Build trustworthy and strong relationship with client staff, physician base and Guidehouse staff

+ Attends mandatory CDI education sessions

Qualifications

Education:

+ Graduation from accredited School of Nursing; BSN or Bachelor’s degree in health related field and/or Masters required OR Graduation from accredited medical school with MD OR CCS Certification

Experience:

+ Minimum of two (2) years as a Clinical Documentation Integrity Specialist required

+ Exhibits strong clinical knowledge with a critical thinking skillset

+ Experienced Clinical Documentation Integrity Specialist (minimum 2 years) with a strong understanding of disease processes, clinical indications and treatments; and provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors. Displays a solid understanding of hospital acquired conditions (HAC’s) , patient safety indicators (PSI’s) and mortality models.

+ Experience with encoder and DRG assignments

+ Maintains working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system

+ Excellent communication skills, with ability to listen and understand client request and needs while employing professionalism and effectiveness

+ Ability to conduct meaningful conversations and /or presentations with providers in all situations

License/Certifications/Registrations:

+ Currently licensed or licensed by endorsement as a Registered Nurse, MD or MD equivalent or credentialed coder with current CCS credential.

+ Must maintain credentials while employed

Preferred Qualifications:

+ Experience with Cerner and Optum

+ CCDS/CDIP Credentials

Additional Requirements

The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described. Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position. Due to our contractual requirements and an Executive Order from the White House, every federal government employee and onsite federal contractor will be asked to attest to their vaccination status. In the interest of health and safety during the continued unprecedented COVID-19 pandemic, anyone who does not attest to being fully vaccinated will be required to follow CDC guidelines which may include (subject to specific contractual requirements): wearing a mask on the job no matter their geographic location, physically distancing from all other employees and visitors, complying to any screening testing requirements. This requirement will apply to Guidehouse employees who work onsite for the federal government.

Disclaimer

About Guidehouse Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our websit To view full details and how to apply, please login or create a Job Seeker account
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Job Posting: JC190045428

Posted On: Aug 15, 2021

Updated On: Nov 26, 2021