Clinical Documentation Integrity - Second Level Reviewer

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The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex, secondary case reviews to facilitate and obtain appropriate provider documentation for clinical conditions or procedures to reflect severity of illness, expected risk of mortality, accuracy of patient outcomes, and complexity of patient care. Serves as key resource for CDI/Coding/Quality. The CDI Second Level Reviewer works in collaboration with CDI & quality leadership, CDI specialists, coders, quality analysts, providers, and other members of the healthcare team to ensure accurate, high-quality clinical documentation to support UHealth initiatives. Adheres to departmental and organizational goals, objectives, standards of performance, policies and procedures, continually ensuring quality documentation and regulatory compliance.

1. Ensures accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes.
2. Performs high-level, complex, timely secondary case reviews concurrently and retrospectively to identify potential gaps or opportunities to facilitate improved provider documentation.
3. Ensure clinical documentation accurately reflects the level of care rendered, severity of illness, risk of mortality, and clinical validation (in compliance with government and other regulations).
4. Applies advanced knowledge of CMS star rating, Vizient, and US News and World Report risk-adjustment systems to identify clinical documentation improvement opportunities.
5. Completes quality reviews focused on CDI quality elements, such as Mortality, Hospital Acquired Conditions (HAC), and other publicly reported patient quality or safety metrics (i.e. AHRQ Patient Safety Indicators).
6. Identify trends and key areas for improvement in querying, coding, and documentation integrity.
7. Demonstrates proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG by providing information regarding clinical documentation opportunities, coding and DRG issues, as well as performance improvement methodologies.
8. Recognizes opportunities for documentation improvement using strong critical-thinking skills and sound judgment in decision making, keeping integrity and compliance at the forefront of considerations in addition to outcomes, reimbursement, and regulatory requirements.
9. Facilitates high-quality documentation by utilizing queries that are effective, clear, concise, and compliant in accordance with latest AHIMA/ACDIS Query Practice Brief.
10. Makes recommendation of possible refinement of principal diagnosis, secondary diagnoses, and/or procedures based on clinical data to facilitate appropriate DRG assignment.
11. Records review findings and other data elements accurately into CDI Software and other data mechanisms to support data integrity for reporting.
12. Effectively and appropriately communicates and collaborates with providers, HIM/coding, quality, CDI, and other members of the healthcare team.
13. Assists with concurrent and retrospective CDI case reviews, quality audits, and education as deemed necessary by CDI Leadership.
14. Works independently; demonstrates effective time management and prioritization of tasks.
15. Participates in meetings, including providing feedback and identifying trends and opportunities, presentations for educational opportunities, and any other needs identified by the CDI leaders.
16. Assumes responsibility for professional development through participation at workshops, conferences, and/or in-services and maintains appropriate records of participation.
17. Participates in departmental and organization projects, task forces, and/or committees as needed.
18. Complies with and ensures adherence to HIPAA and Code of Conduct policies.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Education:
Four (4) Year/bachelor’s degree required; BSN/BS/BA in related field Required; Graduate degree in Healthcare Administration, Informatics, Nursing, Leadership, Education or related field preferred.

Certification and Licensing:
Current RN or MD required; CCDS or CDIP certification required; Coding certification (CCS, CIC, or CPC) preferred.

Experience:
At least three (3) years recent inpatient clinical documentation improvement (CDI) experience required.
Demonstrated extensive clinical knowledge, critical-thinking skills, and understanding of disease processes, pathophysiology, and disease management/treatment required.
At least three (3) years of direct patient care clinical experience in hospital setting preferred.
Proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG required.
At least one (1) year experience with mortality, PSI, HAC, or other quality-focused reviews required.
Knowledge of Vizient, Premier, US News and World Report, CMS star rating or similar risk-adjustment methodologies highly preferred.
Prior experience in an academic medical center (AMC) or large health system preferred.
Proficiency with Microsoft Office (Excel, PowerPoint, Word, Outlook) required.
Proficiency with CDI software and encoder required. Experience with 3M 360 Encompass preferred.
Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Originally posted on Himalayas