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Guidehouse Director, Clinical Documentation Integrity (CDI) in Albany, New York

Overview

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.

Responsibilities

Summary

The Clinical Documentation Improvement Director demonstrates a high level of clinical proficiency and critical thinking skills necessary for oversight and success of the CDI solution. The CDI Director, in collaboration with the hospital clinical leadership, creates a support structure within the medical staff for achieving clinical and operational excellence in relation to Clinical Documentation Improvement efforts. Works collaboratively with Guidehouse and facility CDI leadership team to meet contractual obligations, achieve best practice CDI metrics and assist in meeting overall organizational goals related to documentation improvement. The CDI Director must demonstrate ability to design and manage process and workflow improvements, system implementations and project management. The CDI Director will be instrumental in determining metric measurements that are meaningful to the organization and demonstrate solution success. Will assist in analyzing, tracking, trending and reporting CDI and/or organizational data and metrics. The CDI Director in coordination with the Guidehouse CDI leadership will be responsible to ensure the CDI team has the education and tools necessary to be successful and compliant in their daily, comprehensive, concurrent record reviews, query initiation, posting and follow up. The CDI Director will collaborate extensively and in a collegial manner with the CDI Physician Advisor, Chief Medical Officer (CMO), Chief Quality Officers (CQO’s), other key providers and Department leaders in the review of complex patients. Actively participates on committees and presents the results of studies, trends, and activities as necessary to demonstrate solution performance and improvement in clinical documentation. The CDI Director will escalate issues/concerns to the Vice President of CDI.

Essential Job Functions

  • Expert knowledge/experience in managing all aspects of a Clinical Documentation Improvement Solution to include CDI productivity, quality, education and training, compliance auditing, data analysis and trending, report management, performance improvement initiatives and developing standardized, efficient practices, processes and workflows as well as policies and procedures.

  • Broad knowledge of health care regulations. The ability to interpret, adapt, and apply guidelines and procedures, in addition to the ability to analyze complex clinical scenarios and apply critical thinking

  • Assist in the development of processes, workflows and initiatives designed to improve clinical documentation performance and outcomes

  • Demonstrate effective and meaningful communication skills and collaboration with medical staff, clinical departments and other key facility leadership team members

  • Maintains and demonstrates expert knowledge of CDI and coding process best practices

  • Strong knowledge and understanding in the ever-changing arenas of coding guidelines, DRG payer groups, clinical documentation trends, hospital acquired conditions (HAC’s), patient safety indicators (PSI’s), mortality modeling and core measure guidelines

  • Must have extensive knowledge of reimbursement systems, federal, state, and payer-specific regulations and policies pertaining to documentation and coding

  • Strong project management skills

    Duties and Responsibilities

  • Assist in CDI assessments, staffing analysis and demonstrate ability to quantify opportunities for improvement and return on investment

  • Ability to assess and identify potential health system opportunities for best practice CDI metrics, workflows and documentation improvement

  • Monitors the performance of CDI program to ensure alignment with department and organizational goals

  • Works collaboratively with CDI leadership to hold CDI team accountable for meeting key performance indicators and overarching revenue cycle goals.

  • Drive optimal use of the CDI technology application and reporting capabilities.

  • Efficient use of reporting software to track, analyze and drive continual improvement

  • Assist with CDI technology selection and implementation as required.

  • Lead by example, promoting teamwork and collaboration by fostering positive, transparent and focused working environment to achieve maximum results

  • Cultivates strong, trustworthy relationships among facility leadership team (HIM Director, Coding leadership, Case Management, Quality and Medical staff) resulting in support and participation in initiatives which advance business objectives

  • Become an advocate for facilitating the best practice model for CDI; linking accurate capture of documented bedside care to the most accurate code assignment; to accurately depict the severity of illness and resources consumed for facility and physician profiling, as well as quality and patient safety reporting

  • Ensure query compliance training and query quality review process established, maintained and reported

  • Assist in metric analyses to track performance, trends and escalate issues as necessary.

  • Assist in human resource related activities to include approving employee timesheets, performing mid-year touch points and performance evaluations

  • Active participant in facility meetings

  • Demonstrates a comprehensive understanding of CDI and Revenue Cycle service offerings as well as Guidehouse service offerings.

  • Perceived by the client as a lead for the Guidehouse CDI Solution.

  • Actively participate in the CDI leadership recruiting process.

  • Other duties as assigned.

    Communication:

  • Provides regular status updates to VP of Operations, client and other Guidehouse leaders

  • Demonstrates effective listening and strong facilitation skills.

  • Actively lead meetings with CDI leadership (both internal and client facing) and providers

  • Demonstrates the ability to determine the most appropriate format and scope for client deliverables including the ability to create deliverables suitable for senior-level client and internal audiences.

  • Ability to identify and articulate project obstacles/issues and determine potential solutions while working collaboratively.

  • Expresses self in a confident manner in individual and group settings

  • Other duties as required

Qualifications

Qualifications

At least one of the following: RN, MD, or MD equivalent, RHIA, RHIT or CCS . Holds CDIP or CCDS credential or actively working towards obtaining upon hire

  • Must maintain credential while employed.

  • Requires at least 5 years acute care hospital CDI experience (academic experience preferred)

  • Requires at least 3 years prior management experience.

  • Familiarity with encoder and DRG assignment (MS and APR)

  • Strong clinical understanding of disease processes, clinical indicators and treatment.

  • Maintains current working knowledge of Official Coding Guidelines, Coding Clinic and federal updates to DRG system

  • Excellent communication skills, employing tact and effectiveness.

  • Ability to converse with physicians in sometimes difficult scenarios.

  • Ability to conduct meaningful presentations to facility physicians and leadership.

    Work Environment

  • Some travel may be required (estimated at 10% or less)

  • Flexibility in schedule to meet the client’s needs

Additional Requirements

  • 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.

  • Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.

Disclaimer

About Guidehouse

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.

Benefits include:

  • 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

  • Emergency Back-Up Childcare Program

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