Clinical Consultant Specialist CDI

Description

Job Classification:

• This is an exempt position under the Fair Labor Standards Act (FLSA) and is not eligible for overtime pay.

Our Mission:

Our mission is to drive financial wellness in healthcare organizations so more patients can receive the care they need.

Our Vision:

Our vision is a future where we help healthcare organizations thrive in a complex ecosystem by clearing a path to financial health.

Our Culture:

We are committed to creating a workplace where every member feels valued, empowered, and inspired to contribute their best. Together we will foster a culture that promotes work-life balance and celebrates community engagement, personal achievements, milestones, and special occasions.

Values:

Integrity – We do what’s right, no matter what.

Innovation – We use a harmonious blend of data, tech, and a human-centric approach.

Compassion – We understand the stress of healthcare organizations and their patients.

Determination – Our mission is our guiding force.

Partnership – We build enduring relationships through listening, communication and accountability.

Dignity – We have significant pride in each other and our work.

Job Summary:

The CDI Consultant Clinician would join a team-based environment and be responsible for CDI opportunity identification, and client support. They are also engaged in the process of enhancing the offering we provide to clients, given the tremendous changes already underway and coming up (Value Based Purchasing, Computer Assisted Coding, ICD-10, etc.) to ensure that our clients CDI departments or programs are prepared for these changes.

Candidate would be responsible for education and training, client shadowing and support, chart reviews and audits, DRG downgrade denials, writing appeals, CDI process reviews and enhancements, supporting the enhancement of the department. Work directly with the CDI Director and CDI Chief of Operations to communicate findings and areas of opportunities from case reviews. Participate in multiple engagements with strong teamwork and time management required. Must have deep understanding and knowledge of clinical documentation integrity and stay current with coding updates and changes.

Candidate may also be asked to perform the following duties of a nurse planner for accreditation of learning activities:

• Assess professional practice gaps, identify needs that can be addressed through education, provide feedback with solutions, assist with implementation and evaluation of strategies.
• Identify and resolve conflicts of interest, maintain content integrity.
• Evaluate data to guide future projects.
• Function as a content expert as appropriate.
• Ability to communicate with other stakeholders in other departments for the best outcomes for the program.

This position reports directly to the Executive Director of CDI.

Supervisory Responsibilities:

This position has no direct supervisory responsibilities.

Duties/Responsibilities:

• Maintains knowledge of all federal, state, and local documentation guidelines and communicates changes to all CDI staff; extensive knowledge of I10 and coding guidelines.
• Collaborate with the Chief of CDI to develop, coach, train and mentor CDI specialists and clinical staff to improve documentation practices.
• Ability to appropriately handle stress and interact with others.
• Perform clinical audits of clients and initial reviews of facilities. Provides insight into findings.
• Develops and monitors implementation of program departmental goals/objectives.
• Assist in developing and implementing CDI strategies tailored to client needs and organizational goals.
• Serve as a subject matter expert, advising clients and internal stakeholders on best practices in clinical documentation.
• Ensure documentation meets regulatory requirements, including ICD-10, DRG, and other coding standards.
• Use summative evaluation data to guide future projects.
• Identify gaps in daily operational workflows and provide recommendations for process redesign.
• Other duties as assigned.

Requirements

Knowledge/Skills/Abilities:

• Excellent communication techniques in oral and written form and skills and the ability to manage and prioritize multiple projects
• Strong interpersonal and organizational skills
• Proficient in Microsoft Office applications
• Ability to present to management, staff, and business partners
• Comfortable in a complex and changing healthcare environment
• Broad knowledge of health care regulations including CMS, ICD-10 and DRG optimization along with applicable reporting
• Ability to team effectively with people of various disciplines and backgrounds is essential
• Apply critical thinking and strong organizational skills
• Experienced with risk adjustment and value-based care models
• Extensive knowledge of reimbursement systems; federal, state and payer-specific regulations and policies pertaining to documentation and coding
• Effectively influence and communicate at the peer to C-level, both internally and client facing
• Lean into difficult or ambiguous situations with a result oriented and collaborative mindset
• Knowledge of medical record investigative review
• Demonstrated ability to work independently, exercise good judgment, and be resourceful
• Ability to read, interpret, and strategize future projects, bringing future state to reality
• Proficient in Microsoft Office applications
• Strong interpersonal and organizational skills

Education and Experience:

• Nursing Degree (RN, BS, BSN, or advanced degree)
• Master’s degree in healthcare related field strongly preferred (MSN, MHA, MBA)
• Five years of acute clinical experience
• Experience in Clinical Documentation Improvement (Acute Care)
• Experience with Microsoft Office (Excel, PowerPoint, and Word)
• Minimum of four years of CDI Experience
• Second level review in CDI is highly preferred
• Licensure, certification or registration:
• Current valid multi state license as a Registered Nurse
• Certified Clinical Documentation Specialist (CCDS) or CCDS-O, CDIP
• Master’s degree in healthcare related field strongly preferred (MSN, MHA, MBA)
• CPC, CRC, CCS, etc preferred

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.