Mgr CDI Quality & Educ / HIM Clinical Document Mgmt

Work where every moment matters. 

Every day, over 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. 

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Develops, implements, and manages an effective and comprehensive Health Information Management (HIM) Clinical Documentation Integrity (CDI) quality, audit, education, and denials prevention program consistent with clinical, regulatory, contractual, and professional standards and healthcare revenue cycle industry practices. This position ensures effective and efficient work operation of the unit by managing staff and assigning work according to business needs and collecting data to monitor progress.

Position Responsibilities:

Key Areas of Responsibility

Management, Auditing, Denial Prevention and Management

·       Manages a team of Clinical Documentation Integrity (CDI) Specialists for inpatient CDI, mortality, Patient Safety Indicators (PSIs), Hospital Acquired Conditions (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME) and collaborates with Revenue Cycle Medical Director to provide provider, CDI and coding education for DRG downgrade denials prevention and management. 

·       Validates CDI reviews related to their review process, documentation clarifications/queries and resulting Diagnosis Related Groups (DRGs) to ensure severity of illness and quality of care consistency and efficiency in data collection and quality outcomes reporting for Hartford HealthCare (HHC).

·       Accountable for DRG downgrade denials prevention and internal denial appeal processes. Creates HHC strategies for denial prevention.

·       Accountable for preparing/facilitating written reports on the results of audits and denials, including recommendations for improvements.

·       Presents audit and denial reports, results and action plans to Revenue Cycle leadership, CDI/Coding management for discussion and plans for dissemination to providers, clinical documentation specialists (CDS), and coding professionals.

·       Facilitates the smooth flow of reporting and data in collaboration with the Quality Management Department on mortality, PSI, HAC and other risk adjustment outcomes.

·       Shares accountability to present quarterly Key Performance Indicators (KPI) to compliance office.

·       Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).

Education/Training

·       Creates and implements annual education plan for providers, CDI, coders and other interdepartmental stakeholders across HHC.

·       Develops, creates, and oversees orientation activities for new CDI staff and their mentors.

·       Participates in recruitment and retention strategies.

·       Acts as a resource to CDI leadership for Performance Improvement activities as needed.

·       Provides feedback and creates focused educational/training programs on the results of auditing and monitoring activities for CDS, coders and providers as appropriate in all care settings.

·       Manages CDI education platform (FinThrive or other) assigns assessments and remediation strategies, recommends focused individualized education for CDI team, creates reports and communicates results and action planning to CDI Manager and Supervisors.

·       Provides CDS, coding and provider education on changes in regulations related to CDI.

·       Assists in developing CDI clinical documentation guidelines, standard work, policies, procedures, workflows, and queries and plays a key role in educating staff.

Communication

·       Ensures the appropriate adherence, dissemination and communication of all CMS, coding and HIM regulation, policy, and guideline changes to appropriate stakeholders.

·       Participates in Clinical Quality Council meetings, represents CDI at local and system level by participating in meetings on mortality and harm, and other HHC initiatives related to CDI education.

·       Presents regular updates on denial prevention to providers, CDI and coding professionals.

·       Presents on topics related to clinical documentation integrity in all care settings to all service lines.

·       Maintains system folders with CDI policies, procedures, and educational articles. Maintains and updates content on the CDI Intranet page.

Other Management:

·       Exercises the usual authority of a manager concerning performance improvement plans and reviews, promotions, salary recommendations and terminations. Coaches, develops and inspires staff to maximize their potential.

·       Monitors key performance metrics and works with CDI Manager and Supervisors to adjust operations as needed to meet objectives.

·       Works with key vendor stakeholders to assure optimum value with existing and new technology. Ensures compliance with CDI program (Iodine , other) , collaborates with client manager and other vendor leaders for optimal performance and results.

·       Facilitates CDI team scheduling and Kronos entry to ensure appropriate staffing levels and adherence to Revenue Cycle attendance and PTO policies.

·       Establishes and maintains performance expectations of direct reports, provides timely written performance reviews and 1:1 discussions and provides continuous feedback to enable employees to be successful in their roles.

Other

·       Participates in and contributes to CDI Leadership and Coding/CDI Meetings.

·       Works on general or special assignments and other duties and may lead specialized projects as assigned.

·       Abides by The Ethical Standards for Clinical Documentation Improvement (CDI) Professionals as set forth by the American Health Information Management Association.

·       Perform other related duties as required

Working Relationships:

This Job Reports To (Job Title): HHC Director of Clinical Documentation Integrity

Job Title(s) of HHC positions reporting to this Job: Direct supervision of CDI education, audit and denial team, potential indirect supervision of system wide CDI team in CDI Manager’s absence. Strong working relationships with Revenue Cycle Leadership, physicians, HIM Coding staff, Quality Management, leadership teams and others as needed.

Number-Direct Reports: 5-10

Number-Indirect Reports: 10-30

Required Qualifications

·       Bachelor’s degree in Nursing or equivalent combination of education and experience in accordance with job responsibilities

Experience

·       Minimum

o   Registered Nurse (RN) with 5 or more years CDS experience

o   2 years previous supervisory/ management experience

·       Preferred

o   6+ years’ experience as a CDS

o   Previous management experience preferred

Licensure, Certification, Registration

•     RN licensed in the state of CT

And

•     Certified Clinical Documentation Specialist (CCDS) certification or Certified Clinical Documentation Professional (CDIP) certification

Language Skills

·       Strong written and verbal communication skills. 

Knowledge, Skills and Ability Requirements 

·       Strong understanding of clinical documentation integrity.

·       Understand and support CDI documentation strategies.

·       Knowledge of Pathophysiology and Disease Process, strong clinical skills.

·       Knowledge of Medicare Part A and Part B regulations

·       Working knowledge of clinical informatics.

·       Extensive ability to understand and communicate the impact of CC/MCC’s, PSI/HACs, risk adjustment, and other variables on the assignment of the various DRG methodologies.

·       Specialized understanding and knowledge of ICD-10-CM diagnosis and ICD-10-PCS procedure codes.

·       Strong analytical capabilities.

·       Excellent organizational skills.

·       Strong organizational, critical thinking, problem solving and deductive reasoning skills.

·       Excellent knowledge of Word/Excel/Power Point

·       Strong Encoder and/or Computer Assistant Coding (CAC) skills.

·       Strong ability to:

·       Function independently and handle a flexible work schedule.

·       Travel between facilities as necessary.

·       Handle multiple priorities.

·       Delegate tasks effectively to others.

·       Listen and acknowledge ideas and expressions of others attentively.

·       Converses clearly using appropriate verbal and body language.

·       Collaborate with others to achieve a common goal through mutual cooperation.

·       Influence others for positive and productive outcomes.

·       Work across the Hartford HealthCare System.

·       Utilize subject matter expertise to support coders, other departments, and projects as needed.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.