Senior Consultant - Clinical Documentation Specialist

About the role

The Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.

Responsibilities

• Analyze medical records for inpatient and outpatient service areas for accuracy of coding and documentation to ensure regulatory compliance
• Apply knowledge of medical terminology, disease conditions and procedures to evaluate clinical documents
• Monitor diagnoses, treatments, and follow-up entries in medical records to lead to coding accuracy
• Identify gaps in clinical documentation and request missing information from the appropriate providers
• Develop and implement plans for both formal and informal education of physicians, CDI team, health information management and other clinical staff
• Develop in-service education tools as necessary for physicians, CDI team and ancillary staff and assist physician champion to conduct education as needed
• Train CDI team, physicians and other medical staff on suitable documentation processes to ensure consistency and accuracy of clinical documentation
• Meet with healthcare stakeholders to explain findings and facilitate actions based on recommendations
• Participate in and facilitate executive meetings to explain CDI benchmarks, KPIs and demonstrate overall program accomplishments and challenges through analytics and dashboards
• Conducts and monitors the provider education to ensure appropriate and timely usage of face-to-face meetings, conference calls, Web Conferencing and group facility meetings
• Create and deliver presentations at local and national conferences and/or client meetings
• Keep up to date with advancements changes in regulations pertaining to coding, clinical documentation and health information technology

Requirements

• Bachelor's degree in nursing, medical degree, or physician assistant required
• Current Registered Nurse (RN) license required
• Certified Clinical Documentation Specialist - CCDS (inpatient) certification required
• A minimum of 3 years of experience in acute inpatient settings
• Extensive experience in collecting, interpreting and communicating medical information to select appropriate clients with recommendations and plan of action
• Knowledge of care delivery documentation systems and related medical record documents
• Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes
• Strong analytical skills
• Ability to keep up to date with advancements and regulations in medical coding and clinical documentation
• Proficient in MS Word, Excel and PowerPoint preferred
• Proficient in Electronic Medical Record (EMR) software, such as Epic, Cerner, Allscripts, etc. required
• Excellent verbal and written communication skills with small and large group presentation skills
• Ability to work independently and with multiple teams in a time-sensitive environment
• Ability to travel 50-70%, on average, based on the work you do and the clients and industries/sectors you serve

Qualifications

• Master's degree in Clinical Informatics, Business Administration, Nursing and related health fields preferred
• Case Management or Medical coding certification a plus (CRC, CCA, CCS-P, CCS, CPC, CDIP, CCM)
• Experience as clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG Validation and health IT preferred
• Knowledge of Medicare reimbursement system and coding structures preferred
• In-depth knowledge and experience in medical terminology, medical coding, and ICD-10-CM/PCS, IPPS payment system is a plus
• Experience in quality measurement, quality improvement, and value-based payment models
• Proven applicable CPT and ICD-10 coding experience; APR-DRG, MS-DRG and HCC assignment
• Experience in program and/or project management for technology implementations using third party software
• Knowledge of process excellence (Six Sigma, LEAN, Design Excellence), certifications preferred