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The Medical Director, working together with a coder (DRG Integrity Specialist), will review inpatient charts to ensure the acuity and complexity of the patient's hospital stay is appropriately captured in the clinical documentation and translated into coding.
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This process also involves the Medical Director confirming procedures, dates, and complication or comorbidity (CC) or major complication or comorbidity (MCC) when used as a secondary diagnosis.
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The Medical Director works with the DRG Integrity Specialist to confirm the principal diagnosis and the appropriate Diagnosis Related Group (DRG) of every case in compliance with coding guidelines. Maintain a functional and collaborative relationship with the DRG Integrity Specialist to achieve shared company goals.
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Work with Senior Management and Compliance Officer to adhere to organizational goals and mission. Utilize all technology, tools and resources to enhance performance and will be proficient in navigation of various electronic medical records.
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Independent, focused individual able to work remotely or on-site. Responsible for the quality of their teams work by developing and implementing strategic goals related to quality improvement within the tower.
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Work with their manager to review tower analytics, identifying trends and actionable steps to improve opportunity capture rate and drive results for clients. The Medical Director is responsible for capturing the true clinical picture in a manner compliant with federal laws and the healthcare organization's information privacy practices through identification of coding and physician query opportunities.
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Exceed expectations in performance with regard to productivity and quality of his/her tower work, professionalism, and professional growth. Minimum of a total of 5 years of clinical experience including residency.
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Ability to improve MS-DRG assignments related to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
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Ability to use a PC in a Windows environment, including MS Word, Excel and PowerPoint. The Medical Director validates clinical indicators for coded diagnoses, capturing the patient's condition and ensuring the accuracy of the severity of illness and risk of mortality for the patient to illustrate the true clinical picture of the episode of care.
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Preferred completion of an ACGME accredited US residency program. Provide clinical leadership in an inter-disciplinary team in a professional, knowledgeable, and efficient manner to drive client results, exceed client expectations, and foster client confidence.
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The Medical Director is responsible for overseeing every chart assigned to their team. Stays up to date with medical guidelines, advancements within his or her field, and client-specific criteria. Responsible for generating compliant queries based on appropriate clinical indicators for each diagnosis.
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Resolve conflicts quickly and professionally. Take on additional responsibilities and demonstrate leadership at a departmental level. Performs miscellaneous job-related duties as assigned. Every query must meet all regulatory and reporting requirements.
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Excel in a fast-paced, rapidly changing environment. Participate in corporate educational activities. Comply with medical and federal guidelines at all times. Service, compassion, and humanism. Graduate from an accredited medical school.
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Basic Microsoft Office skills. Ability to work as part of a team.
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Monitors performance as demonstrated through CMI, CC/MCC capture rate, physician response rate, RAC reviews, HCC's, coding accuracy rates and other financial and quality metrics. Responsibilities include Coding, Clinical Documentation Improvement (CDI), Physician Advisor Program, and other Coding/CDI specific activities within ECU Health and the facilities it supports.
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