Guidehouse Clinical Documentation Integrity (CDI) Specialist- Remote in Albany, New York
Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.
The Remote Clinical Documentation Integrity (CDI) Specialist is responsible for conducting concurrent inpatient chart reviews on assigned units to ensure documentation is complete and accurate at the time of discharge to properly reflect the severity of illness and resources consumed for timely, accurate and compliant coding. Initiates queries in a professional, non-leading manner to clarify ambiguous or conflicting documentation, obtain specificity of diagnoses, and connect treatment performed to a diagnosis (if known). Performs coding, working DRG assignment and enters all review activity into tracking software. Perform any and all related job duties as assigned. This position is 100% Remote.
Conducts daily, concurrent review of inpatient records on assigned unit(s), to ensure complete and accurate physician and or clinician documentation is present at the time of discharge for accurate, timely, and compliant coding.
Reviews daily admissions to assigned unit, performs initial code assignment for a working DRG and completes CDI software data entry for initial and follow up case reviews (or worksheet to include code and DRG assignment) and submits to Program Assistant
Updates “working DRG” as documentation supports or physician query answer supports a change in the DRG assignment.
Communicates to the CDI Coordinator when volume of daily review assignments is too high or low so that CDI Coordinator can assist in adjusting review assignments amongst the team.
Initiates compliant physician queries when documentation is confusing, ambiguous or missing and follows up with MD to seek immediate response to query (utilizing the following AHIMA practice briefs as a guide: “Managing an Effective Query Process”, October 2008 and “Guidance for Clinical Documentation Improvement Programs”, May 2010).
Ensures the query verbiage is in no way leading or suggestive in tone and is supported by the documentation in the record to include clinical indications and treatment provided.
Performs follow up on incomplete physician queries to obtain an answer while the patient is stlll in house.
Analyzes complete clinical documentation from a compliance, coding and/or reimbursement perspective including rationale for the initiation, discontinuation and/or adjustment of treatment modalities utilized in the care of the patient.
Assures physician has sufficient documentation for corresponding diagnosis of all monitored, evaluated or treated illnesses and initiates queries as appropriate.
Identifies possible documentation risk areas, including missing orders, patient identification, legibility issues and poor documentation trends.
Provides daily feedback and education to physicians on the quality of documentation and presents examples of how physician documentation can improve compliance based on CMS guidelines.
Promotes accurate DRG classification according to standards set forth by CMS (Center for Medicare & Medicaid Services) to reduce documentation-related-risks associated with DRG-based payers.
Assures record reflects the patient’s severity of illness and risk of mortality (ROM) to improve accuracy of hospital case mix index, national comparisons and physician profiles.
Possesses a clear understanding of MS DRG guidelines and required documentation components for accurate code/DRG assignment.
Keeps abreast of Coding Clinic updates, to include code changes, MCC and CC changes and/or changes in the DRG system to effectively educate DI team and physician and clinical team members regarding changes.
Keeps abreast of Recovery Audit Contractor (RAC) review activity to avoid potential risk for the facility.
Assists in developing reports as needed for the review and analysis of facility specific documentation and reimbursement patterns
Assists in development of physician and/or clinician education
Provides accurate and up-to-date information on regulatory and reimbursement requirements
Works closely with case management, physicians, clinicians, and departments to improve communication regarding documentation and reimbursement issues
Investigates and responds timely to questions regarding documentation or coding issues.
Educates physicians, clinicians, and departments on documentation, coding, and reimbursement guidelines and facilitates understanding of payer and regulatory requirements
Attends scheduled physician education/training sessions on clinical units and/or MD offices as requested on a daily and/or weekly basis.
Builds trustworthy and strong relationship with client staff, physician base and Guidehouse staff.
Stays current on documentation & billing requirements to ensure compliance with all regulatory and governmental agencies
Observes confidentiality and safeguards all patient-related information.
Serves as a role model for all co-workers by setting an example of high standards in dress, conduct, cooperation and job performance
Meets or exceeds established quality and productivity standards.
Checks e-mail system at a minimum of three times per day: beginning, middle, and end of working day.
Assists with coding backlogs and performs other duties as assigned.
Graduation from accredited School of Nursing; BSN or Bachelor’s degree in health related field and/or Masters required OR
Graduation from accredited medical school; MD or DO required, or RHIA/RHIT with CCS Certification
Minimum of two (2) years as a Clinical Documentation Integrity Specialist preferred Exhibits strong clinical knowledge with a critical thinking skillset
Experienced Clinical Documentation Integrity Specialist (minimum 2 years) with a strong understanding of disease processes, clinical indications and treatments; and provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors. Displays a solid understanding of hospital acquired conditions (HAC’s), patient safety indicators (PSI’s) and mortality models.
Experience with encoder and DRG assignments
Maintains working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to the DRG system
Excellent communication skills, with ability to listen and understand client request and needs while employing professionalism and effectiveness
Ability to conduct meaningful conversations and /or presentations with providers in all situations
- Currently licensed or licensed by endorsement as a Registered Nurse, MD or MD equivalent or credentialed coder with current CCS credential.
Experience with 3M Collaborate and Meditech
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave and Adoption Assistance
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
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