Manager, Enterprise CDI-Inpatient (Clinical Denials)

Clinical Documentation Improvement Program Manager

Plans, directs, and manages functions within the Clinical Documentation Improvement (CDI) Department. Plans, manages, executes and delivers high quality CDI programs. Responsible for design, collection, and reporting of relevant data to support the System CDI Program.

Minimum Qualifications :

Education, Certification, and / or Licensure :

1. Bachelor's Degree in Health Information Management with successful completion of the Registered Health Information Administrator (RHIA) Exam; OR Bachelor's Degree in Nursing Services with either West Virginia Registered Nurse (RN) credential or Licensed Practical Nurse (LPN) credential; OR Associate Degree in Health Information Technology with successful completion of the Registered Health Information Technicians (RHIT) examination.

2. Must have one of the following Certified Credentials within one (1) year of hire :

Clinical Documentation Practitioner (CDIP) OR Certified Clinical Documentation Specialist (CCDS).

Experience :

1. Two (2) years' experience in clinical documentation improvement.

2. Two (2) years supervisory experience.

Core Duties and Responsibilities :

1. Responsible for Management of Clinical Documentation Improvement Program. Provides Hospital Coding Specialists and CDI Specialists with clear guidance on coding and DRG assignment. Oversees education to this group no less than twice a year on coding and DRG updates. Reviews CDI monthly statistics and continues to suggest areas of improvement. Communicates with Director at standing meetings of the program's progress. Oversees quarterly CDI audits.

2. Develops and manages audit tools and data collection to monitor accuracy of clinical coding and documentation improvement. Develops and manages quality standards for the area. Oversees quality validation on DRG / APR DRG assignment for accuracy and compliance as relates to CDI.

3. Manages and provides oversight of the Clinical Documentation Improvement Program to ensure optimal documentation and program effectiveness. Obtains and interprets data and direction from monitoring and Advisory agencies (e.g. ACDIS, AHIMA, United HealthCare Consortium and The Advisory Board Company Compass etc.) Reviews interpreted data to Coding& Documentation Specialists, at a minimum on a quarterly basis. Manages preparation and distribution of physician score card reports. Identifies problem areas and areas of improvement as well as provides oversight for education and improvement plans in all CDI areas.

4. Directs instructions and education activities for WVUH physicians and ancillary staff on coding and documentation related issues. Promotes compliance with CMS, Joint Commission and coding & billing regulations. Oversees the development and coordination of ongoing CDI education for new staff, including physicians, coders, nurses and allied health professionals.

5. Oversees leads and manages initiatives and projects in the area of Clinical Documentation Improvement. Provides oversight in establishing high quality expectations and ensuring compliance with these expectations. Oversees implementation of controls and metrics to reduce data collection issues and improve data quality as pertains to CDI.

6. Performs employee performance reviews at least annually and interviews, hires, coaches, counsels and dismisses employees as necessary.

7. Maintains statistics for productivity, budget indicators, and hospital reporting. Develops and applies performance standards for each of the assigned units. Develops the current expense and capital equipment budgets and quarterly variance reporting for the System CDI department in collaboration with the CDI Director.

8. Participates and represents the CDI Department on various hospital committees and medical staff committees as assigned. Functions as member of the Legal Electronic Health Record Committee.

7. Develops and evaluates departmental procedures as they pertain to operations to increase the efficiency and productivity of the department workflow. Perform ongoing evaluation of staff productivity and workflow to best utilize manpower in reaching and maintaining productivity goals. Reports to director as changes are made. Updates policies and procedures on an annual basis.

Physical Requirements : 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.

1. Must be able to sit for long periods of time.

2. Must have visual and hearing acuity within the normal range.

3. Must have manual dexterity needed to operate computer and office equipment.

Working Environment : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. May be exposed to standard patient care environment.

3. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.

4. May require travel.

Skills and Abilities :

1. Must possess excellent written and verbal communication skills, as well as interpersonal skills necessary to communicate effectively.

2. Must possess the knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required.

3. Must possess the ability to mentor, educate and train others.

4. Must meet quality and productivity standards.

5. Must be able to handle high stress and critical situations in a calm and professional manner.

6. Must be able to concentrate and maintain accuracy during constant interruptions.

7. Must possess independent decision-making ability.

8. Must possess the ability to prioritize job duties.

9. Must be able to adapt to changes in the workplace and work assignments.

10. Must possess organizational and time management skills.

11. Must possess the knowledge of anatomy, physiology and medical terminology.

12 Must possess analytical and problem solving skills.

13. Must be proficient in office software programs.

14. Must possess the ability to analyze complex data and reports.

Additional Job Description : This individual will be over the clinical denial portion of our department.

Scheduled Weekly Hours : 40

Shift :

Exempt / Non-Exempt : United States of America (Exempt)

Company : SYSTEM West Virginia University Health System

Cost Center : 538 SYSTEM HIM CDI