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Clinical Documentation Integrity Specialist
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- The CDI Specialist assesses the clinical documentation through extensive reviews of the medical record, interaction with all members of the healthcare team, Quality department and the Health Information Management (HIM) Coding team to ensure appropriate coding and DRG assignment for the level of services rendered to the patient and to ensure that the clinical information utilized in profiling and reporting outcomes is complete and accurate.
- Ensures hospital case-mix index and severity profiles are accurate by performing timely medical record review, determination of working DRG assignment and applying clinical expertise to identify opportunities for improved or clarified documentation that accurately reflects the severity of illness and risk of mortality of the patient.
- Demonstrates proficiency in establishing and reconciling DRG processes compliant with departmental guidelines and CMS regulations.
- Comprehends the impact of accurate clinical documentation in the medical record beyond establishing a working DRG: accurate billing, public reporting, research data, quality metrics, provider scorecards, accuracy of the UHDDS, Case Mix Index (CMI).
- Demonstrates skills of high efficiency and accuracy to identify and reduce DRG downgrades/denial risks by assuring that clinical support is beyond dispute for DRG integrity, coding and billing needsMeets established operational and productivity standards.
Expired 13 days agoInactive Job
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