Clinical Documentation Improvement Quality Analyst

Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

This position will exist to serve the CDI Manager with responsibility for specific tasks that require an experienced level of skill and understanding within the CDI department to include auditing of staff performance, participation in interdepartmental work efforts and other activities as defined. This position will initially create and continually maintain, with the assistance of the CDI leadership, an Education Training/Coding Remediation program that will ensure success for Clinical Documentation Specialists based on their specific needs (i.e. new hires, current employees). This position will be accountable for developing and maintaining a culture of service, compliance, and integrity in the CDI department and ECU Health.

Responsibilities

AUDITING FOR CDI EXCELLENCE

Perform regular audit assessments and verifications; evaluate processes for compliance/education effectiveness to identify educational and improvement opportunities, including discrepancies in clinical indicators and diagnostic statements which impact DRG assignment, severity of illness, risk of mortality and resource utilization.

Perform a quantitative and qualitative review and analysis of health records and physician queries, both concurrently and retrospectively, to ensure documentation is accurate, consistent, complete and assigned codes can be supported by documentation. Conduct chart reviews based on DRGs and Care Site-specific trends to identify gaps in documentation and training opportunities.

Utilize analysis of a variety of data sets, dashboards and audits to assist in identifying gaps, root causes and solutions for Clinical Documentation Specialists and physician leadership. Provide audit findings to the CDI Leadership team to assist with development of an action plan when improved opportunities are identified. Act as the subject matter expert (SME) and resource for the Clinical Documentation Specialists.

Develop, coordinate and complete internal monitoring and auditing activities to ensure compliance with documentation, coding and billing practices. In collaboration with the CDI Manager, analyze provider performance measures and assist in identification of provider specific education needs related to CDI process and clinical documentation. Collaborate with CDI Manager and Physician Advisor team on the development of Clinical Documentation Specialist and Physician education materials to ensure consistency.


CLINICAL VALIDATION AND QUALITY INITIATIVES

Participate in review for clinical validation denial cases and clinical validation processes prebill.

Provide expertise in reviewing cases identified through CDI reconciliation, query validation and as requested by the Coding team through the DRG mismatch process.

Actively engage with other departments throughout the organization to support initiatives as it related to documentation integrity.


EDUCATION ACTIVITIES

Serve as subject matter expert for CDI staff, participate in productive discussions regarding case reviews and principles of CDI and partner with key positions within the

Coding/Auditing team for IP Coding.

Will be responsible for training new employees in the various computer systems used for CDI review activity.

Will prepare and monitor a standard training schedule for each new employee that will facilitate learning, progression and successful mastery of each area of CDI.

Participate in educational experience relating to CDI for 2-year and 4-year Health Information students.

Assume the role of the Clinical Documentation Specialist providing additional CDI support to ECU Health as needed (i.e. vacancies, increased patient volumes, vacations, medical leave, other).

Other duties as assigned.

Minimum Requirements

Nursing (BSN preferred) (ADN required) or higher.

3 years recent CDI experience.

Certification (CCDS or CDIP required).

At least 4 years experience providing direct patient care to acute and chronically ill patients in inpatient settings, critical care, ED or strong med-surg experience preferred.

Evidence of progressive leadership experience is essential, as is demonstration of organizational, critical thinking and communication skills.

Strong written, verbal and interpersonal communication skills required.

Evidence of proficiency with computer skills and related tasks.

Coding, Case Management and/or Utilization Review experience preferred.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.