This is a regional director level position which supports acute care hospitals within the program for clinical documentation improvement. This position uses masters level project management, clinical knowledge & knowledge of coded data for documentation requirements to improve overall patient quality, capture severity, acuity & risk of mortality. In addition to having expertise in understanding the clinical documentation required for the completeness of the patient records using a multidisciplinary team process. Provides oversight, leads & directs a regional clinical documentation improvement program & staff. Position includes recruiting, hiring & supervising RNs & HIM coding professional who are CDI staff. Works w/ hospital & regional teams to reach goals & objectives of the program which include quality, safety, data integrity & accurate reimbursement. This position functions within the Regional HIM (Health Information Management) Department as part of the Revenue Cycle.
Essential Functions:
- Implement & provide oversight for a regional clinical documentation improvement program in an organized & standardized manner.
- Recruit, hire & train clinical documentation improvement staff (50+ FTEs) that will function at the medical centers (hospitals).
- Mentor & supervise CDI staff.
- Establish effective working relationships w/ the local & regional staff/teams/leadership.
- Facilitate appropriate clinical documentation to support diagnosis capture. Identifies & reviews primary & secondary diagnosis & complications to ensure diagnosis & Identify & review for POA (Present on Admission), Hospital Acquired Conditions (HACs) documentation & initiate a communication clarification process when appropriate w/ providers.
- Reviews clinical issues w/ medical coding staff & w/ physicians to identify those diagnoses that impact severity of illness indicators) for each patient.
- Serves as an expert resource in reviewing all medical records in support of consistent documentation for all payer types to ensure complete & accurate diagnosis capture & coding.
- Adheres to the hospital standards to promote a cooperative work environment by utilizing communication skills, interpersonal relationships & team building.
- Collaborates in the development of programs, initiatives & workflows which provide alignment w/ education for internal customers to support clinical documentation guidelines.
- Communicates information timely & effectively w/ medical center leaders & clinical staff.
- Works w/ Regional Coding Review Managers & the Regional Director of Coding to develop, implement & monitor departmental policies & procedures that support organizational goals, business objectives, regulatory needs & requirements.
- Conducts quality assurance reviews on the CDI processes & functions, resulting in the reporting of any corrective action.
- Collaborates w/ the HIM Director of the medical centers, dietary, speech, physical, respiratory & wound care staff.
- Provides education to these service lines & department leadership.
- Conducts data & root cause analysis, provides feedback & shares findings on the analysis to leaders, local regional management & medical team.
- Leads the 'Query process' to medical staff for accurate clear documentation in the patient's medical records.
- Monitor & track verbal & written queries & produce reports as required.
- Provide input on RAC issues relating to clinical documentation.
Secondary Functions:
Establishes strategic direction & determines operational vision for Regional HIM Coding. This includes establishing and implementing Coding infrastructure to meet current and future Regulatory changes that impact coding processes. Also responsible for establishing and maintaining relationships with senior leaders of the Medical Group through meetings, providing information, reviewing coding performance, and balancing priorities.
Develops, coordinates, and oversees implementation of departmental policies and procedures that support revenue cycle, and organizational goals, timely, complete and accurate coding, business objectives & workflow standardization. Reports to the Regional HIM Managing Director.
Qualifications:
Basic Qualifications:
- Minimum of eight (8) years of clinical experience (i.e. inpatient, clinical documentation, &/or case management reviews).
- Prior Clinical Documentation Improvement experience, either as a specialist or as a program manager/leader.
- Experience w/ Recovery Audit Contractors (RAC).
- Acute care inpatient care experience & extensive knowledge of MS-DRG, APR-DRGs or similar methodology preferred.
- Graduate from an accredited school of nursing (BSN required).
- Current licensure to practice as a Registered Nurse in the State of California. Master's degree preferred.
- CCDS (Certified Clinical Documentation Specialist) or CCS (Certified Coding Specialist) optional.
- CCDS, certified clinical documentation specialist preferred.
- CCS (Certified Coding Specialist) optional preferred.
- Expert interpersonal, communication (verbal, non-verbal, & listening skills).
- Understand Adult Learning Theory.
- Knowledge of HCCs (Hierarchical Condition Categories) & inpatient clinical documentation issues preferred.
- Understand coding classifications systems such as, but not limited to ICD-9 CM, MS-DRG, APR-DRGs, & HCCs strongly preferred.
- Strong ability to present to multiple physician advisory boards, steering committees & executive staff on the importance of documentation improvement, & effectiveness of CDI & its goals & objectives.
- Collect, analyze & interpret data (CDI) for physician endorsement of program initiatives.
- Facilitate understanding, compliance, & completeness in documentation.
- Ability to Combine clinical knowledge & business acumen to deliver results w/ a track record of assessing & capitalizing on opportunities for streamlining operations through broad based experience in project leadership & process reengineering.
- Consistently produce client deliverables faced w/ multiple project resource constraints.
- Utilize training in understanding of the DMAIC process &/or Black or Green Belt certifications.(ie.Six Sigma methodologies).
- Must exhibit efficiency, collaboration, candor, openness, & results orientation. - Knowledge of the healthcare revenue cycle.
- Competent computer skills including word processing, spreadsheets, & presentation software
- Must have strong analytical skills.
- Demonstrate an understanding of the operations &/or business of KP, health policy trends, & any applicable regulations related to the responsible practice area.
Preferred Qualifications:
- AA Health Information Technology or related field; BA or BS preferred.
- RHIT or RHIA.
- Substantial experience (10 years) in health information management field.
- Significant experience (5+ years) as a healthcare HIM Director /Coding Director.
- Demonstrated ability to understand, utilize and apply methods, principles, practices, and techniques related to coding of health information data.
- Demonstrated leadership experience with results-oriented approach; must excel in a collaborate and consensus building environment.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.