Granville Health System
CDI Specialist
Granville Health System, Oxford, North Carolina, United States, 27565
Summary:The CDI Specialist is responsible for improving the overall quality and completeness of our clinical documentation. The CDI Specialist interacts with physicians, patient care providers, and coders to establish principal and secondary diagnoses, procedures, and promote appropriate DRG, APC, and ER Leveling assignments. They identify and help resolve documentation issues, provide training, appeal insurance denials and DRG downgrades, and report compliance variances. They report variances to the Director of the HIM Department, Compliance Officer, or Hospital hotline.
Duties:
Concurrently review patient chart documentation during hospital admission to ensure complete and accurate patient records, including the use of Present on Admission indicators.Obtain documentation relevant to denials avoidance related to Recovery Audit program, CERT program, and other audit programs. Recognize and disseminate to physicians the importance of clinical documentation for both the physician and the hospital.Review medical necessity denials and provide constructive feedback to providers.Work with all physician specialties in clinical documentation improvement initiatives, tailoring learning and education opportunities to each physician specialty on an "as you go" basis.Collaborate with case managers to capture patient severity of illness and intensity of service to ensure medical necessity.Collaborate with Coding Team to ensure proper documentation.Register and attend all relevant ICD-10 and other billing/coding related educational offerings by CMS contractors. Share key concepts and elements with physicians, integrating them into daily routines and practices of CDI.
Required:Graduate from a Board approved nursing program with current licensure as a registered nurse in the state of North Carolina required. Familiarity with MS-DRGs and the Inpatient Prospective Payment System (IPPS), including new CMS guidelines. Practical knowledge and understanding of official physician E&M guidelines and documentation requirements to support proper E&M assignment and establishment of medical necessity. Effective communication of benefits of complete and accurate documentation to physicians relating to their daily practice.
Preferred:BSN preferred. CCDS and/or CCS preferred or 3 years relevant clinical experience in CDI preferred. Working knowledge of meditech and 3M encoding software preferred.#J-18808-Ljbffr
Duties:
Concurrently review patient chart documentation during hospital admission to ensure complete and accurate patient records, including the use of Present on Admission indicators.Obtain documentation relevant to denials avoidance related to Recovery Audit program, CERT program, and other audit programs. Recognize and disseminate to physicians the importance of clinical documentation for both the physician and the hospital.Review medical necessity denials and provide constructive feedback to providers.Work with all physician specialties in clinical documentation improvement initiatives, tailoring learning and education opportunities to each physician specialty on an "as you go" basis.Collaborate with case managers to capture patient severity of illness and intensity of service to ensure medical necessity.Collaborate with Coding Team to ensure proper documentation.Register and attend all relevant ICD-10 and other billing/coding related educational offerings by CMS contractors. Share key concepts and elements with physicians, integrating them into daily routines and practices of CDI.
Required:Graduate from a Board approved nursing program with current licensure as a registered nurse in the state of North Carolina required. Familiarity with MS-DRGs and the Inpatient Prospective Payment System (IPPS), including new CMS guidelines. Practical knowledge and understanding of official physician E&M guidelines and documentation requirements to support proper E&M assignment and establishment of medical necessity. Effective communication of benefits of complete and accurate documentation to physicians relating to their daily practice.
Preferred:BSN preferred. CCDS and/or CCS preferred or 3 years relevant clinical experience in CDI preferred. Working knowledge of meditech and 3M encoding software preferred.#J-18808-Ljbffr