Description

Summary/Objective
The CDI Specialist will ensure accuracy and quality among medical coders, providers, nurses, billing teams, and other healthcare staff and also work collaboratively with Care Coordination teams to help identify and close care gaps.

Core Responsibilities

Daily Operations

1. Excellent customer service including answering phone promptly and professionally.
2. Uses problem solving skills to solve problems with staff and/or billing procedures.
3. Identify opportunities to impact risk adjustment factors through documentation of complicating and comorbid, or major complicating and comorbid conditions and formulate a provider query based on query guidelines with timely provider follow-up.
4. Complete provider clarification queries per guidelines for stances in which documentation in the medical record is ambiguous, incomplete, or conflicting, and provide timely provider follow-up as needed.

Collaboration and Communication

1. Facilitate communication and collaboration among coders, providers, and nurses to identify documentation opportunities that appropriately reflect severity of illness and risk of mortality.
2. Recommend strategies for improving record keeping processes, attend meetings to present current clinical documentation trends, findings, and provide education on the impacts of clinical documentation.
3. Analyzes medical information to assist healthcare staff in providing superior services for patients.
4. Interprets clinic reports to identify health-related patterns and assists in addressing patient health problems.
5. Works with physician and clinic leadership to develop and monitor key performance indicators for clinical documentation.
6. Meets with clinical staff and providers to explain reports.

Compliance

1. Applies knowledge of medical terminology and medical procedures to properly evaluate clinical documents.

1. Ensure all clinical documents are in compliance with federal laws in terms of composition.
2. Prepares written reports for internal monitoring and compiles data for reporting.
3. Tracks information on diseases.
4. Conducts research and perform administrative duties.
5. Takes education courses and stays up to date on changes in laws governing clinical documentation.

Other Duties as assigned. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

1. Required:
   • Associated Degree in HIM or Billing/Coding
   • Minimum of 3 years of clinical coding experience in a hospital or physician practice environment
   • Must have at least one of the two types of credentials:
     • HIMS processional candidates credentialed as an RHIA, RHIT, CPC, or CCS
     • Clinical candidates must be credentialed and hold current Idaho State or Compact State license as an LPN, RN, BSN (C-CDIS is a plus)
   • Experience with ICD-10 CM Coding
   • Excellent oral and written communication skills
   • Be organized and able to set priorities and meet deadlines.
   • Proficient computer skills in Microsoft Office Suite software products
   • Ability to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly.
   • Knowledge of pertinent Federal, State, and local laws, codes, and regulations
2. Preferred

HIM Management experience or Experience with Cerner, highly preferred