Clinical Documentation Integrity - Second Level Reviewer

About the role

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. They serve as a key resource for CDI/Coding/Quality, collaborating with various healthcare team members to ensure accurate, high-quality clinical documentation.

Responsibilities

• Serves as key resource for CDI/Coding/Quality
• Works in collaboration with CDI & quality leadership, CDI specialists, coders, quality analysts, providers, and other members of the healthcare team
• Ensures accuracy, completeness, and quality of clinical information used for measuring and reporting physician and hospital outcomes
• Performs high-level, complex, timely secondary case reviews concurrently and retrospectively to identify potential gaps or opportunities to facilitate improved provider documentation
• Applies advanced knowledge of CMS star rating, Vizient, and US News and World Report risk-adjustment systems to identify clinical documentation improvement opportunities
• 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)
• Identifies trends and key areas for improvement in querying, coding, and documentation integrity
• 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
• Makes recommendations of possible refinement of principal diagnosis, secondary diagnoses, and/or procedures based on clinical data to facilitate appropriate DRG assignment
• Records review findings and other data elements accurately into CDI Software and other data mechanisms to support data integrity for reporting
• Effectively and appropriately communicates and collaborates with providers, HIM/coding, quality, CDI, and other members of the healthcare team
• Affords assistance with concurrent and retrospective CDI case reviews, quality audits, and education as deemed necessary by CDI Leadership
• Works independently; demonstrates effective time management and prioritization of tasks
• Participates in meetings, including providing feedback and identifying trends and opportunities, presentations for educational opportunities, and any other needs identified by the CDI leaders
• Assumes responsibility for professional development through participation at workshops, conferences, and/or in-services and maintains appropriate records of participation
• Participates in departmental and organization projects, task forces, and/or committees as needed
• Complies with and ensures adherence to HIPAA and Code of Conduct policies

Requirements

• 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
• Current RN or MD required; CCDS or CDIP certification required; Coding certification (CCS, CIC, or CPC) preferred
• 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

Qualifications

• 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

Skills

• Advanced knowledge of CMS star rating, Vizient, and US News and World Report risk-adjustment systems
• Strong critical-thinking skills and sound judgment
• Proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG
• Experience with mortality, PSI, HAC, or other quality-focused reviews
• Knowledge of Vizient, Premier, US News and World Report, CMS star rating or similar risk-adjustment methodologies
• Prior experience in an academic medical center (AMC) or large health system
• Proficiency with Microsoft Office (Excel, PowerPoint, Word, Outlook)
• Proficiency with CDI software and encoder
• Experience with 3M 360 Encompass
• Excellent written and verbal communication skills

Benefits

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

Pay

Competitive salary offered.

Schedule

Full-time Employee Type: Staff