Responsible to provide administrative, human resource, and financial management for the Clinical Documentation Improvement outpatient department and program. Reviews the progress of the documentation audit program and serves as a resource to physicians and administration regarding issues related to the appropriateness of physician and outpatient documentation and coding. Assists Director in the development, implementation, and maintenance of department metrics and performance improvement initiatives. Mentors and coaches staff to facilitate achievement of department and organizational goals and supports day-to-day operational requirements including appropriate scheduling and coverage of audits, educating physicians, monitoring the program, and refining the process as needed.
- Manages a staff responsible for performing thorough chart reviews of documentation and coding practices, providing education, acting as regulatory expert on coding and billing related issues.
- Provides oversight for educating the medical staff and other caregivers as necessary via written/verbal communication to obtain accurate and complete physician documentation. Works collaboratively with the healthcare team to facilitate documentation within the medical record that supports multiple outpatient reimbursement and quality models.
- Demonstrates a thorough understanding of CPT, ICD-10 and their impact on quality, and financial indicators.
- Serves as a technical resource for the CDI staff, providers, practice managers and/or other operational leadership.
- Provides leadership in the day-to-day scheduling of staff to assure appropriate scheduling and coverage, development and prioritization of audits and education, monitoring the program and refining the process as needed.
- Supervises assigned staff. Selects, counsels, prepares performance evaluations, and terminates according to policy.
- Assists in providing feedback to Compliance and Audit Services on risks related to documentation and coding patterns.
- Monitors data and provide reports as required to evaluate progress.
- Leads efforts in process improvement initiatives.
- Performs other duties as required or assigned.
- Bachelor’s degree in a relevant field or the equivalent in education and experience required.
- Seven (7) years of professional or outpatient coding experience required.
- Knowledge of care delivery documentation systems and related medical record documents (Epic diagnostic data base and EMR tools).
- Expertise in reviewing medical documentation for accuracy.
- Ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate coding.
- A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement - allowing an understanding of the impact of coding on payment models.
- Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code CPT®, ICD-10-CM, and HCPCS Level II.
- Excellent written and verbal as well as critical thinking skills to facilitate ongoing communication with administrative and Provider partners.
- Ability to work independently in a time-oriented environment, as well as collaboratively with members of the organization.
Required Licensure/Certification Skills:
CPC, COC or CCS-P certification