As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Responsible for reviewing medical records to facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient, by improving the quality of the physiciansï¿½ clinical documentation. Exhibits a sufficient knowledge of clinical documentation requirements, MS-DRG Assignment, and clinical conditions or procedures, Educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Record Review: Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to: (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate MS-DRG assignment, risk of mortality and severity of illness; and (b) initiate a review worksheet. Conducts follow-up reviews of patients every 2-3 days to support and assign a working or final MS-DRG assignment upon patient discharge, as necessary. Formulate physician queries regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the health record, as necessary. Collaborates with case managers, nursing staff and other ancillary staff regarding interaction with physicians regarding documentation and to resolve physician queries prior to discharge.
Assist in training department staff new to CDI
Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls as well as any required CDI education.
CDI: Communicates/Completes Clinical Documentation Improvement (CDI) activities and coding issues (lacking documentation, physician queries, etc.) for appropriate follow-up and resolution
Other duties as assigned
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
CDI Specialist must display teamwork and commitment while performing daily duties
Must demonstrate initiative and discipline in time management and medical record review
Travel may be required to meet the needs of the facilities
Advanced knowledge of Medicare Part A and familiar with Medicare Part B
Intermediate knowledge of disease pathophysiology and drug utilization
Intermediate knowledge of MS-DRG classification and reimbursement structures
Critical thinking, problem solving and deductive reasoning skills
Effective written and verbal communication skills
Knowledge of coding compliance and regulatory standards
Excellent organizational skills for initiation and maintenance of efficient work flow
Regular and reliable attendance and time reporting per Conifer Telecommuting program requirements
Capacity to work independently in a virtual office setting or at facility setting if required to travel for assignment
Understand and communicate documentation strategies
Recognize opportunities for documentation improvement
Formulate clinically, compliant credible queries
Ability to maintain an auditing and monitoring program as a means to measure query process
Ability to apply coding conventions, official guidelines, and Coding Clinic advice to health record documentation
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
Preferred: Acute Care nursing relevant experience
Zero (0) to two (2) years of experience
Graduate from a Nursing program, BSN, or graduate
CERTIFICATES, LICENSES, REGISTRATIONS
Active state Registered Nurse license
Preferred: CDIP or CCDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to sit for extended periods of time
Must be able to efficiently use computer keyboard and mouse
Good visual acuity
Must be able to travel nationally as needed, not to exceed 10%
Primary Location: Louisville, Kentucky
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1905037045
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.