CDI Second Level Reviewer

The Second Level Reviewer, Clinical Documentation Integrity (CDI) Specialist, is a CDI professional with a broad clinical knowledge base and advanced understanding of DRG documentation requirements who works under the supervision of the CDI Manager, in collaboration with Inpatient Coding and Coding Quality & Education Team.  This individual is responsible for comprehensive secondary clinical chart reviews at the system level including, but not limited to: Concurrent and retrospective medical record review for defined patient populations to identify opportunities for documentation improvement and integrity, serve as CDI representative for DRG validation audits/appeals, Mortality reviews, Quality reviews including patient safety indicators (PSIs) and hospital acquired conditions (HACs), Query quality assurance checks for compliance, and collaborating with Health Information Management (HIM), Coding, and Quality departments to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards.

This position is eligible for benefits!

Some of the benefits we offer at Fairview include medical insurance - as low as $0, dental insurance - also a $0 option, PTO (24 days per year starting), and a 403B with up to a 6% employer match; visit www.fairview.org/benefits to learn more and get all the details.

• Utilizes critical thinking skills and clinical reasoning to analyze and interpret clinical data to identify gaps, inconsistencies, and/or opportunities for improvement of the clinical documentation to reflect the appropriate clinical status of the patient and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for Compliant Query Writing; impacting quality reporting, physician/facility/organization public data, reimbursement, public health data, and disease tracking and trending.
• Complete comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and/or code discrepancies; mortality reviews to ensure documentation supports severity of illness and risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnosis as identified by leadership for potential missed opportunities to clarify documentation or clinically validate a diagnosis.
• Performs daily case reviews and identifying diagnoses and procedures in order to assign accurate working DRG. Perform follow-up medical record reviews to identify additional diagnoses or procedures that may impact the DRG, SOI, or ROM assignment. Confers with coders to ensure appropriate final DRG and completeness of supporting documentation.
• Develops physician education strategies in conjunction with the Coding Quality & Education team to promote complete and accurate clinical documentation and correct negative trends. Confers with nursing, case management, utilization review and other clinical caregivers to explain the importance of clear and concise documentation.
• Communicates, as appropriate, findings of secondary reviews to respective Clinical Documentation Specialist for follow-up and query initiation.
• Identifies educational opportunities to be presented to CDI Staff, Management, Quality and Medical care professionals regarding importance of accurate and complete documentation, the impact on quality of data and quality metrics
• Collaborative interaction with physicians and/or other clinicians to enhance understanding of the CDI program goals; ensure the medical record can be coded accurately to accurately reflect patient severity of illness and risk of mortality
• Collaborates with other clinical disciplines (i.e., quality, case management etc.) and members of the coding department to ensure high quality clinical documentation and efficient, timely coding of the medical record.
• Participates in performance improvement activities related to the operational processes for Clinical Documentation Integrity as well as related organizational/departmental goals.
• Assists CDI Leadership in making recommendations for process improvements to further enhance coding quality and integrity goals, and assists in establishing and maintaining policies and procedures for CDI.
• Develops collaborative relationships, promoting teamwork with co-workers and other departments.
• Subject matter expert for CDI Concurrent Review Teams.
• Maintains professional competency in documentation and coding practices by keeping up to date on new coding guidelines, policies/procedures, federal and state reimbursement.
• Performs other duties as assigned.

Organization Expectations, as applicable:

• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served.

• Partners with patient providers to assist with care/decision making.
• Communicates in a respective manner.
• Ensures a safe, secure environment.
• Modifies interventions based on population served.

• • Fulfills all organizational requirements.
    • Completes all required learning relevant to the role.
    • Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures, and standards.
  • Fosters a culture of improvement, efficiency, and innovative thinking.
  • Performs other duties as assigned.

Required Qualifications

Education

Associate degree (or higher) in Nursing or Health Information Management (HIM) degree or related field or equivalent experience.

Experience

At least 2 years as a Clinical Documentation Integrity (CDI) Specialist

License/Certification/Registration

One of the following: RHIT, RHIA or RN  

Preferred Qualifications

Education

Bachelor's degree (or higher) in Nursing or Health Information Management (HIM) or related filed or equivalent experience

Experience

5 years of experience as a Clinical Documentation Integrity (CDI) Specialist.

License/Certification/Registration

One of the following: CCDS, CDIS, CDIP, CDEI, CCS, CPC, CCDSO or CCIO

Additional Requirements:

• Knowledge of medical terminology, anatomy and pathophysiology, pharmacology, ancillary test results.
• Knowledge of ICD-10-CM and DRG classification systems.
• Knowledge of physician and nursing unit practices.
• Excellent interpersonal, analytical critical thinking, problem solving and conflict management skills to foster a positive working environment.
• Computer and data analysis skills.
• Excellent verbal and written communication skills.
• Builds effective partnerships with other coding and documentation staff, ancillary staff, and medical providers, fostering open lines of communications and establishing trust.
• Responsible for following all coding, payer, and regulatory guidelines for compliant and accurate code assignment.
• Uses denials information and trends to improve documentation capture at the point of care.
• Proficiency in computer skills, including Microsoft products (i.e., Teams, Word, Excel, Outlook), EPIC, and other programs, as assigned.
• Ability to work independently, self-motivate, and adapt to change while accommodating special projects, deadlines, and priorities as assigned.
• Attention to detail: Achieve thoroughness and accuracy when accomplishing a task.
• Analytical Thinking: Ability to identify issues, obtain relevant information, relate, and compare data from different sources and identify alternative solutions.  
• Critical Thinking: Gathers and integrated critical information, recognizing and addressing underlying assumptions of others to arrive at effective solutions.  
• Medical Staff Relations: Builds effective partnerships with medical staff, physicians, fostering open lines of communications and establishing trust. 
• Problem Solving: Identifies problems, determines accuracy and relevance of information, utilizes appropriate tools and staff resources along with sound judgment to generate and evaluate alternatives and to make recommendations.  
• Written Communication: Ability to organize and express information and ideas in written form to individuals as well as groups. Constructs messages that are clear and convincing.  
• Must exercise independent judgment, critical thinking, ability to work independently while utilizing available provided resources, while also following CMS guidelines, organizational policies, and procedures.