Nurse Cdi Specialist Phso - Remote

Description

AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift: Monday-Friday

Job Location: Remote; Need to be able to go onsite for training, if needed

The role you’ll contribute:

The Nurse CDI (Clinical Documentation Improvement) Specialist will be responsible for utilizing their clinical/nursing knowledge, and understanding of current CMS coding guidelines, conventions and AHA coding clinics to improve the overall quality and completeness of the patient medical record. Through a multidisciplinary team process, the Nurse CDI Specialist performs pre-visit and retrospective reviews of ambulatory clinical documentation to ensure accurate depiction of the true complexity of the patient. This includes compliant documentation to support the capture or Hierarchical Condition Categories (HCC), ICD-10-CM accuracy and specificity, and medical necessity. They work collaboratively with physicians, advanced practice providers, coders and clinical documentation analysts to communicate opportunities and educate members of the patient care team regarding documentation guidelines, coding requirements and service-line specific requirements. They communicate with coders, compliance specialists and/or clinical documentation analysts regarding documentation clarification and accurate coding, as needed. This position is responsible for understanding the clinical Care Gaps for different populations, using physicians’ education and multi-disciplinary team approach to help closing them. Participates in select committees and provides education programs as necessary. Analyzes cost savings, utilization, and outcome reporting for trending and opportunities to impact change. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you’ll bring to the team:

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

• Responsible for utilizing their clinical/nursing knowledge, deep knowledge of chronic and complex illness, and understanding of current CMS coding guidelines, conventions and AHA coding clinics to improve the overall quality and completeness of the patient medical record.

• Performs pre-visit and retrospective reviews of ambulatory clinical documentation to ensure accurate depiction of the true complexity of the patient. This includes compliant documentation to support the capture or Hierarchical Condition Categories (HCC), ICD-10-CM accuracy and specificity, and medical necessity.

• Collaborates with multidisciplinary teams to develop analytic strategies to assess the quality of Outpatient CDI program (with HCC & RAF Scores)

• Pulls data from multiple sources and produces reports related to Outpatient CDI, quality, safety, throughput, access, and value on both a recurring and ad hoc basis, to meet the needs of a diverse set of customers.

• Communicate with Physicians, Medical Management leaders, Coding and Risk Adjustment Operations, PHSO Medical Director, coders, compliance specialists and/or clinical documentation analysts regarding documentation clarification and accurate coding, as needed.

• Facilitates appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with physicians, case management staff, nursing staff, other patient caregivers, and coding staff. With Director and Supervisor’s guidance, collaborates with coding staff to develop standard coding guidelines, policies and procedures.

• Demonstrates knowledge of documentation requirements and coding guidelines that pertain to outpatient diagnosis coding to accurately reflect the complexity and medical necessity of the visit.

• Routinely provides education to physicians, advanced practice providers and other key healthcare providers regarding the need for accurate, specific, and complete clinical documentation in the patient's medical record

• Delivers provider specific metrics and coach providers on problem list and RAF gap closing opportunities as needed.

• Participates in meetings committees, and educational programs as needed.

Qualifications

The expertise and experiences you’ll need to succeed:

KNOWLEDGE AND SKILLS REQUIRED:

• Ability to develop, evaluate and improve workflows including ability to create process documentation

• Expertise in computer skills including excel, powerpoint, word, and reporting software

• Knowledge of healthcare operations

• Knowledge and understanding of medical terminology and medical reporting

• Strong background in chronic disease management

• Communicate professionally in reporting results

• Ability to interact effectively with physicians and other health care professionals

• Able to be independent in daily work

• Clinical operations knowledge

• Able to identify, analyze and effectively solve problems

• Ability to prepare reports and presentations, and building/maintaining statistical spreadsheets

• Ability to function in a high-paced environment

• Utilize and demonstrate excellent critical thinking, problem-solving and deductive reasoning skills

KNOWLEDGE AND SKILLS PREFERRED:

EDUCATION AND EXPERIENCE REQUIRED:

• Nursing degree OR equivalent years of experience with comprehensive knowledge and understanding of chronic and acute disease conditions, management, and treatment

• Comprehensive knowledge and understanding of utilization management criteria (i.e.: InterQual, Milliman)

• Experience with Clinical Documentation Reviews, Medicare risk adjustment, Hierarchical Condition Categories, coding, billing, auditing

• Minimum of two years’ experience with, modeling, and report development

EDUCATION AND EXPERIENCE PREFERRED:

• Advanced degree in medical field and/or coding

• Greater than 2 years experience in, outpatient clinical documentation reviews and improvement processes

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

Nursing licensure as a Licensed Practical Nurse (LPN) in good standing with the State of Florida and/or Nursing Compact

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

• Nursing Licensure as a Registered Nurse (RN) in good standing with the State of Florida and/or Nursing Compact

• Current Certification in Clinical Documentation Improvement (CDIP, CCDS, CCDS-O, CDC, and/or CDEO

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.