Clinical Documentation Integrity Educator/ Quality Auditor

Organization:

CPMC-California Pacific Med Center Van Ness

Position Overview:

Under the direction of the CDI Leadership Team, the role of the CDI Educator/Quality Auditor provides education to CDS team members. The CDI Educator/Quality Auditor will be responsible for onboarding and continued education in the areas of coding, clinical documentation integrity and regulatory and billing compliance. The CDI Educator/Quality Auditor will be responsible for maintaining the CDS staff education database, creating, and delivering formal and informal education, tracking compliance and responding to requests for education and ensuring all education opportunities are available to the CDI department. This position works with CDI leadership to ensure all new team members receive coding and documentation education during onboarding and works with the CDI Data Analyst as needed to ensure current documentation practices meet compliance requirements. The CDI Educator/Quality Auditor uses clinical knowledge, code assignment, documentation requirements, and reimbursement methodologies to review the work of clinical documentation improvement specialists. The goal of the audit is to improve documentation and patient quality, and capture severity, acuity, and risk of mortality. Documented results will be used to track and trend the success of the overall program, provide educational follow up, and identify changes in medical practice that should be reflected in documentation. Targeted feedback will be provided to team members on a monthly cadence based upon audit findings.

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JOB DESCRIPTION:

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES:

• Provides analysis of queries with “not agreed,” “other explanation,” and “unable to determine,” responses.
• Surveys, catalogs, and reports on formal education and onboarding education success via provider responses and compliance tracking.
• Performs CDI QA reviews to identify missed MCC/CC/PDX selection opportunities for concurrent and retrospective reviews.
• Identify and review for accurate MCC/CC capture, appropriate POA assignment, HAC/PSIs, and provider queries.
• Identifies trends/opportunities for improvement in documentation habits of service line and reports that information to the CDI group during collaborative meetings.
• In addition to the key accountabilities listed, employees working in this position are expected to accept and perform other duties as requested.
• Works in collaboration with CDI leadership and CDI Data Informaticist to ensure current documentation practices meet compliance requirements.
• Responsible for creation and delivery of a quarterly newsletter to inform all end-users and department leadership of regulatory updates, new resources available, ongoing CDI program information, upcoming CEU opportunities, new service line initiatives, etc.
• Shares QA audit findings with CDI Staff on a monthly basis and educates staff members on missed query / coding SLR opportunities.
• Conduct data analysis, identify trends, and share findings via formal reporting mechanism.
• In collaboration with CDI leadership, coding, designs, implements, and maintains formal and informal educational materials, presentations, and assessments to support CDI team education development.
• Performs DRG-level audits on “unoptimized” DRGs, to identify missed documentation / coding opportunities and identifies area for improvement.
• Serves as an expert resource for CDI staff, clinical care providers, and coding professionals.
• Facilitates appropriate clinical documentation to support diagnosis capture, ensure appropriate level of service is provided, and support severity of illness.
• Perform ongoing compliance reviews to ensure department query compliance rates meet and exceed target goal of 95%.
• Supports the CDI leadership in trending the impact of CDI Education on Providers’ query agreement rates, “documentation scores” (to be established), and other objective KPIs related to severity capture.

EDUCATION:

Bachelor of Science in Nursing

TYPICAL EXPERIENCE:

5 years of progressive CDI experience with a working knowledge of core CDI administrative operations.

CERTIFICATION & LICENSURE:
RN-Registered Nurse of California

Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP)

Upon hire or within one year of hire, candidate is required to obtain Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).

Other: Foreign trained physicians

SKILLS AND KNOWLEDGE:

Subject matter expertise in the area of clinical documentation to ensure the completeness of the patient records using multidisciplinary and interdisciplinary teams.

High degree of hospital coding knowledge, including but not limited to APR-DRG, MS-DRG, HCCs, Medicare, Medicaid & Managed Care, in order to design and develop strategies to yield improvements to documentation that will improve overall patient quality, capture severity, assess acuity and determine risk of mortality.

Thorough knowledge of clinical documentation requirements, clinical procedures, disease processes, treatments, and the patient populations served.

Subject matter expertise regarding quality and reimbursement implications of clinical documentation and coding.

Up-to-date knowledge of ICD-10 mandate and the impact of code set transition, including potential impact on data quality for prospective payments, utilization, and reimbursement.

Demonstrated familiarity and adept use with software and technical applications including but not limited to: Microsoft Office products (Outlook, Excel, Word, PowerPoint), Electronic Health Records, Encoder, Healthcare databases.

Strong Organization and Quantitative Analysis skills including spreadsheet applications and statistics.

Pay Range: $63.74-$95.60/ hou

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Variable

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.