East Orange, New jersey
Regional Director of Clinical Documentation Improvement Job Opening in East Orange, New jersey - Summary:
The Regional Director of Clinical Documentation Improvement (CDI) will be responsible for development and execution of CDI program for assigned Prospect Medical Holdings. The Regional Director of CDI will play a key role in ensuring the success of major revenue cycle initiatives and be responsible for the performance of staff within the department according to key KPI?s.
Responsibilities include:
Ensuring all staff is adequately trained and equipped to carry out their daily clinical documentation work.
Monitoring performance of staff under him/her using departmental KPIs.
Ensuring the success of major revenue cycle initiatives.
Providing strategic planning and concentrated daily oversight of the Clinical Documentation Improvement Program.
Defining, implementing, and monitoring strategies for improving clinical documentation resulting in quality of care, optimal case mix index, and overall consistency of clinical documentation and coded data.
Facilitating modifications to clinical documentation through extensive interaction with physicians and midlevel providers, nursing staff, other patient caregivers and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a DRG based payor (Medicare, Medicaid, other payers).
In conjunction, with other department heads (HIM, Case Management, Quality), the Regional Director of CDI will lead the effort to ensure that accurate DRG-based reimbursement for the hospital is achieved and claim denials are reduced, by ensuring documentation integrity.
Promoting accurate concurrent documentation from all disciplines (physicians, case managers, nurses, dietitians, wound care specialists etc.) to capture best practice documentation for specific diagnoses. The Regional Director of CDI will also conduct regular retrospective reviews for coding accuracy, missed opportunities, consistency of documentation and education of CDS and coding staffs.
Ensuring the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes.
Developing strategies that will address risk adjustment and other quality measures that address hospital and physician performance.
Ensuring that his/her team is abreast with regulatory and compliance changes that impact the department?s operation.
Reviewing data/metrics with providers at Medical staff meetings as well as on individual physician basis.
Providing ongoing education to all members of the medical staff.
Facilitating optimal collaborative relationships with the medical staff including education opportunities, utilization management, health information management and other clinical staff.
Evaluating regulatory changes and educate staff appropriately.
Serving as a translator between Finance and the Clinical Staff, and playing a vital role in improving accurate quality reporting for both provider and the facility.
Interfacing with compliance, management, and key physician leaders at the hospital as it prepares strategically for a competitive future.
Performing other departmental duties listed in the position description and as assigned.
Requirements:
The individual should have regular, reliable, predictable attendance in performance of essential job functions.
The individual should meet or exceed expected time lines on performance level related to personnel, budgeting and reporting responsibilities.
The individual should have a thorough understanding of denials management and clinical appeal and will play an active role in denials management through formulation of strategies to minimize denials and drafting of credible appeals
The individual will work with hospital leadership, physicians, and other providers to improve the overall quality and completeness of clinical documentation in the medical record to ensure that an accurate reflection of the severity of illness and the quality of care is captured.
The individual will work to educate providers on the value of more granular documentation to their quality scores, risk of mortality data, length of stay, and continuity of care for the patient.
Qualifications:
Certified Clinical Documentation Specialist.
Certified Clinical Documentation Improvement Practitioner.
Certified Coding Specialist.
Minimum of 3-5 years working in healthcare Clinical Documentation Improvement.
Practical Floor CDI experience.
5 years? experience DRG Auditing.
Practical experience in Clinical Appeals.
Leadership training and monitoring CDI Specialists.
Leadership skills and prior management experience is required.
Additional education in Healthcare Finance, Federal and State Regulations, Revenue Cycle Management and Healthcare Quality.
Additional post graduate education relevant to the healthcare industry is preferred.
Job Type: Full-time
Required education:
Bachelor's
Required experience:
DRG Auditing: 5 years
Practical in Clinical Appeals: 3 years
working in healthcare Clinical Documentation Improvement: 3 years
Leadership training and monitoring CDI Specialists: 3 years
Leadership skills and prior management: 3 years
Required licenses or certifications:
Certified Clinical Documentation Specialist.
Certified Coding Specialist
Certified Clinical Documentation Improvement Practitioner
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