Spaulding Hospital - Boston and Cambridge
Clinical Documentation Integrity Manager
Spaulding Hospital - Boston and Cambridge, Charlestown, Massachusetts, us, 02129
Description
Job SummaryThe Clinical Documentation Integrity Manager (CDIM) is responsible for the day-to-day management of the CDI team. The Manager provides support to CDI specialists (CDIs) in coordinating all CDI operational processes and works to achieve and maintain CDI and Compliance departmental goals.Under the direction of the Spaulding chief Compliance Officer, facilitates improvement in the overall quality, completeness and accuracy of medical record documentation for the purposes of ensuring compliance with Medicare, Medicaid (CMS) regulations and guidelines and to expedite appropriate reimbursement. Assists with IRF CMS 60% management, concurrent DRG/CMG/PDPM assignment, diagnosis documentation gaps and ongoing documentation integrity and clinical staff new hire orientation.Key ResponsibilitiesPartners with CDI Medical Director to educate physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the medical record.Manages day-to-day CDI operationsIn collaboration with the Spaulding Coding Manager, assures compliance with Official Coding Guidelines, Regulatory Compliance Guidelines and CDI policiesPlan, direct, organize and manage the CDI team to meet key performance indicators (CMI, LOS, PI, others as applicable)Coordinate meetings and education for the CDI Team on IRF, LTCH, SNF documentation requirements, EHR updates and notifies the team of coding/billing updates as needed with Coding ManagerRepresents the CDI Team at meetings and committeesCoach, facilitate, problem solve CDI workflowsAssist in hiring, onboarding, orientation and training of new team membersComplete ongoing and annual performance evaluations of CDI team membersAssists Compliance Officer in the review and improvement of documentation and CDI processes and servicesAssists with Preparation of CDI reports including key CDI program metrics to senior managementApprove PTO requests, assuring adequate staff coverage utilizing FT, PT, per diem resourcesAids the CDI team (IRF, LTCH, SNF) with valid clinical reviews and compliant physician queriesMaintains and develops Compliant Physician Query Templates located in the Electronic Health Record.Assists Corporate Compliance Officer with developing CDI metrics and report system for IRF and LTCH (supports SNF MDS staff who act as CDIs for SNF level of care, includes financial impacts and query trendsAssists the Senior Financial Analyst or other colleague, in developing, maintaining, and updating CDI Metrics databases (or other collection tools) for IRF and LTCHAssists CDI team with daily inpatient reviews within 24- 72 hours of admission (by day four for Functional Measures review) and throughout hospitalization to:
a) evaluate documentation that supports the coder's assignment of the reason for admission and/or etiologic diagnosis, principal diagnosis, and comorbidities and complications that support the CMG/DRG/PDPM. This does not include a review of the impairment group code assignment for the IRF.b) document, review details in Epic for physician notification and responseAssists CDI team to conduct concurrent follow up reviews of patients to support and assign additional diagnoses that may impact length of stay. Queries physicians regarding missing, unclear or conflicting medical record documentation by requesting and obtaining additional documentation within the medical record as applicableCollaborates with CDI Medical Director, Chief Compliance Officer, case managers, nursing staff and other ancillary staff as applicable to resolve physician queries prior to patient discharge.Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement.Assists the Outcomes Manager/applicable staff with trending, tracking, and educating the Interdisciplinary Team based on external (i.e., PEPPER) and internal data to improve outcomes.Applies diplomacy and professionalism when interacting with physicians and clinical staff; especially when addressing missing or conflicting medical record informationActs as a consultant to providers, management, administration and billing staff regarding documentation, coding, and reimbursement and compliance matters.Assists CDI team or directly provides orientation for new clinical staff regarding documentation requirements and coding/billingAssists in coordinating responses to third party payer audits and/or requests when appropriateKeeps current with reimbursement and coding changes, proposed and otherwise, through conferences, reference material and review of current literatureMaintains confidentiality of all customer/hospital information.Demonstrates flexibility in the face of changing work environment, adjusting work schedule accordingly.Upholds the Spaulding Organizational Values of Innovation, Collaboration, Accountability, Respect, and ExcellencePerform other duties as assigned
Strategic Relationships
Develops and strengthens collaborative relationships with stakeholders to advance the care of our patientsActively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationshipsDelivers information in a clear, concise and compelling mannerDelivers targeted and actionable communications that invites two-way professional communication; adjust messages appropriately by audienceDemonstrates a willingness and ability to assist others
Self-DevelopmentDemonstrates proficiency in current and emerging technologies (Epic, Microsoft Office)Simultaneously uses multiple technologiesIndependently takes proactive steps toward problem resolutionCompletes all mandatory and assigned education by established deadlinesAttends scheduled meetings and continuing education programs
Qualifications
Qualifications and ExperienceGraduate of an accredited School of Nursing.1+ year of CDI experience requiredCurrent licensure from the Massachusetts Board of Registration to practice professional nursingCertificate in Case Management or Clinical Documentation Improvement (CDIP) preferredMinimum of 5 years experience in either clinical nursing, case management, HIM inpatient coding or an equivalent combination of these disciplinesKnowledge of post-acute regulatory/accreditation requirements preferredBasic knowledge of coding/classification systems appropriate for inpatient CMG and DRG prospective payment systemComputer proficiency required; Microsoft office applications preferred with ability to learn new software.High level of service delivery. Demonstrate initiative with ability to prioritize work, meet deadlines and adapt to changing situations.Work independently, be self-directed and contribute as a leading member of a team.Ability to clearly present information in writing and in presentation form.Maintain variable work schedule to meet department needs. (evenings, holidays, weekends and limited travel).
EEO Statement
SRN is committed to diversity in the workplace which begins with respect and opportunity for all. SRN takes affirmative action to ensure that equal employment opportunity is provided to all persons regardless of race, religious creed, color, national origin, sex, sexual orientation, gender identity, genetic information, age, ancestry, veteran status, disability or any other basis that would be inconsistent with any applicable ordinance or law. If you need a reasonable accommodation in coming to or participating in the interview process, please let us know.Primary Location: MA-Charlestown-SRH Spaulding Rehabilitation Hospital Boston Work Locations: SRH Spaulding Rehabilitation Hospital Boston 300 1st Avenue Charlestown 02129 Job: Nursing-Other Organization: Spaulding Hospital-Boston & Cambridge(SRN,SRH,SHC) Schedule: Full-time Standard Hours: 40 Shift: Day Job Employee Status: Regular Recruiting Department: SRH Compliance & Outcomes Job Posting: Oct 24, 2024
Job SummaryThe Clinical Documentation Integrity Manager (CDIM) is responsible for the day-to-day management of the CDI team. The Manager provides support to CDI specialists (CDIs) in coordinating all CDI operational processes and works to achieve and maintain CDI and Compliance departmental goals.Under the direction of the Spaulding chief Compliance Officer, facilitates improvement in the overall quality, completeness and accuracy of medical record documentation for the purposes of ensuring compliance with Medicare, Medicaid (CMS) regulations and guidelines and to expedite appropriate reimbursement. Assists with IRF CMS 60% management, concurrent DRG/CMG/PDPM assignment, diagnosis documentation gaps and ongoing documentation integrity and clinical staff new hire orientation.Key ResponsibilitiesPartners with CDI Medical Director to educate physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the medical record.Manages day-to-day CDI operationsIn collaboration with the Spaulding Coding Manager, assures compliance with Official Coding Guidelines, Regulatory Compliance Guidelines and CDI policiesPlan, direct, organize and manage the CDI team to meet key performance indicators (CMI, LOS, PI, others as applicable)Coordinate meetings and education for the CDI Team on IRF, LTCH, SNF documentation requirements, EHR updates and notifies the team of coding/billing updates as needed with Coding ManagerRepresents the CDI Team at meetings and committeesCoach, facilitate, problem solve CDI workflowsAssist in hiring, onboarding, orientation and training of new team membersComplete ongoing and annual performance evaluations of CDI team membersAssists Compliance Officer in the review and improvement of documentation and CDI processes and servicesAssists with Preparation of CDI reports including key CDI program metrics to senior managementApprove PTO requests, assuring adequate staff coverage utilizing FT, PT, per diem resourcesAids the CDI team (IRF, LTCH, SNF) with valid clinical reviews and compliant physician queriesMaintains and develops Compliant Physician Query Templates located in the Electronic Health Record.Assists Corporate Compliance Officer with developing CDI metrics and report system for IRF and LTCH (supports SNF MDS staff who act as CDIs for SNF level of care, includes financial impacts and query trendsAssists the Senior Financial Analyst or other colleague, in developing, maintaining, and updating CDI Metrics databases (or other collection tools) for IRF and LTCHAssists CDI team with daily inpatient reviews within 24- 72 hours of admission (by day four for Functional Measures review) and throughout hospitalization to:
a) evaluate documentation that supports the coder's assignment of the reason for admission and/or etiologic diagnosis, principal diagnosis, and comorbidities and complications that support the CMG/DRG/PDPM. This does not include a review of the impairment group code assignment for the IRF.b) document, review details in Epic for physician notification and responseAssists CDI team to conduct concurrent follow up reviews of patients to support and assign additional diagnoses that may impact length of stay. Queries physicians regarding missing, unclear or conflicting medical record documentation by requesting and obtaining additional documentation within the medical record as applicableCollaborates with CDI Medical Director, Chief Compliance Officer, case managers, nursing staff and other ancillary staff as applicable to resolve physician queries prior to patient discharge.Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement.Assists the Outcomes Manager/applicable staff with trending, tracking, and educating the Interdisciplinary Team based on external (i.e., PEPPER) and internal data to improve outcomes.Applies diplomacy and professionalism when interacting with physicians and clinical staff; especially when addressing missing or conflicting medical record informationActs as a consultant to providers, management, administration and billing staff regarding documentation, coding, and reimbursement and compliance matters.Assists CDI team or directly provides orientation for new clinical staff regarding documentation requirements and coding/billingAssists in coordinating responses to third party payer audits and/or requests when appropriateKeeps current with reimbursement and coding changes, proposed and otherwise, through conferences, reference material and review of current literatureMaintains confidentiality of all customer/hospital information.Demonstrates flexibility in the face of changing work environment, adjusting work schedule accordingly.Upholds the Spaulding Organizational Values of Innovation, Collaboration, Accountability, Respect, and ExcellencePerform other duties as assigned
Strategic Relationships
Develops and strengthens collaborative relationships with stakeholders to advance the care of our patientsActively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationshipsDelivers information in a clear, concise and compelling mannerDelivers targeted and actionable communications that invites two-way professional communication; adjust messages appropriately by audienceDemonstrates a willingness and ability to assist others
Self-DevelopmentDemonstrates proficiency in current and emerging technologies (Epic, Microsoft Office)Simultaneously uses multiple technologiesIndependently takes proactive steps toward problem resolutionCompletes all mandatory and assigned education by established deadlinesAttends scheduled meetings and continuing education programs
Qualifications
Qualifications and ExperienceGraduate of an accredited School of Nursing.1+ year of CDI experience requiredCurrent licensure from the Massachusetts Board of Registration to practice professional nursingCertificate in Case Management or Clinical Documentation Improvement (CDIP) preferredMinimum of 5 years experience in either clinical nursing, case management, HIM inpatient coding or an equivalent combination of these disciplinesKnowledge of post-acute regulatory/accreditation requirements preferredBasic knowledge of coding/classification systems appropriate for inpatient CMG and DRG prospective payment systemComputer proficiency required; Microsoft office applications preferred with ability to learn new software.High level of service delivery. Demonstrate initiative with ability to prioritize work, meet deadlines and adapt to changing situations.Work independently, be self-directed and contribute as a leading member of a team.Ability to clearly present information in writing and in presentation form.Maintain variable work schedule to meet department needs. (evenings, holidays, weekends and limited travel).
EEO Statement
SRN is committed to diversity in the workplace which begins with respect and opportunity for all. SRN takes affirmative action to ensure that equal employment opportunity is provided to all persons regardless of race, religious creed, color, national origin, sex, sexual orientation, gender identity, genetic information, age, ancestry, veteran status, disability or any other basis that would be inconsistent with any applicable ordinance or law. If you need a reasonable accommodation in coming to or participating in the interview process, please let us know.Primary Location: MA-Charlestown-SRH Spaulding Rehabilitation Hospital Boston Work Locations: SRH Spaulding Rehabilitation Hospital Boston 300 1st Avenue Charlestown 02129 Job: Nursing-Other Organization: Spaulding Hospital-Boston & Cambridge(SRN,SRH,SHC) Schedule: Full-time Standard Hours: 40 Shift: Day Job Employee Status: Regular Recruiting Department: SRH Compliance & Outcomes Job Posting: Oct 24, 2024