CDI Quality Reviewer (Remote)

Memorial Hermann Health System; Houston, Northern (TX, KY); Hybrid; USD 75,000 - 95,000; Full time

Job summary

Memorial Hermann Health System in Houston seeks a CDI Quality Reviewer to conduct secondary reviews, resolve DRG and code discrepancies, and partner with clinicians to improve documentation quality and compliance.

Requirements include a Nursing degree and Texas license, 3 years CDI experience, and relevant certifications; proficiency with Epic EMR and 3M tools is preferred. This on-site role reports to the CDI Quality/Education Manager.

Qualifications

• Bachelor's in Nursing is required; Master’s in Nursing or Management preferred.
• Current Texas nursing license (or temporary/compact).
• One of CCDS, CDIP or CCS certifications is required.
• Three years of CDI experience required.

Responsibilities

• Performs comprehensive secondary reviews to identify missed documentation opportunities.
• Resolves DRG or code discrepancies in collaboration with CDI and Coding teams.
• Educates CDI staff and collaborates with clinicians to improve documentation quality.
• Ensures documentation reflects severity of illness and mortality risk per CMS guidelines.
• Maintains knowledge of ICD-10 guidelines and participates in Coding Clinics.
• Communicates findings to CDI Manager and provides provider education as needed.
• Supports safe care and adheres to Memorial Hermann policies within budget and schedule.

Skills

Analytical skills

Communication skills

Detail-oriented

Team player

Education

Bachelor's in Nursing

Master’s Degree in Nursing or Management (preferred)

Tools

Epic EMR

3M Coding

MS Office

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The Clinical Documentation Integrity (CDI) Quality Reviewer responsibilities include comprehensive secondary clinical chart reviews to identify potential missed opportunities for documentation clarification, act as a liaison between coding and CDI to resolve Diagnosis-Related Group (DRG) or other code discrepancies, collaborate with CDI educator to educate CDI team based on opportunities identified in second level reviews and work directly with clinicians and providers to improve the overall quality and completeness of documentation through the query process and/or provider education. The CDI Quality Reviewer will collaborate closely with Coders, Coding Quality Auditors, Quality Department and Providers to assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or other regulatory standards. Typically reports to the CDI Quality/Education Manager.

Job Description

Must Have CDI Experience to Be Considered for This Position

MINIMUM QUALIFICATIONS

Education: Bachelor's of Nursing, required; Master’s Degree in Nursing or Management preferred.

Licenses/Certifications: Current State of Texas license or temporary/compact license to practice professional nursing

One of the following is required:

• Certified Clinical Documentation Specialist (CCDS) from the Association of Clinical Documentation Improvement Specialists
• Certified Clinical Documentation Integrity Professional (CDIP) from the American Health Information Management Association (AHIMA)
• Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA)

Experience / Knowledge / Skills:

• Three (3) years of Clinical Documentation Integrity (CDI) experience required
• Approved AHIMA ICD-10-CM/PCS Trainer preferred
• Previous CDIS auditing, denial and Vizient experience preferred
• Strong computer proficiency including working knowledge of MS Office- Word, Excel and Outlook and 3M Coding and Reimbursement software; experience with Epic EMR preferred
• Excellent communication, analytical and problem-solving skills are essential
• Strong organizational skills and must be detail oriented
• Highly analytical with strong risk assessment, impact analysis and problem- solving skills
• Highly self-motivated, yet demonstrate ability to be a team player and take direction
• Flexible and able to multi-task and prioritize daily workload, performing concurrent chart reviews as needed

PRINCIPAL ACCOUNTABILITIES

• Completes comprehensive, clinical secondary reviews of targeted patient populations to include cases with DRG and/or code discrepancies; mortality reviews to ensure documentation supports risk of mortality; hospital acquired conditions (HACs), patient safety indicators (PSIs) or other top priority diagnoses as identified for potential missed opportunities to clarify documentation or clinically validate a diagnosis.
• Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for a Compliant Query Practice.
• Acts as a liaison between the Coding Department and Clinical Documentation Integrity to reconcile discrepancies in code and/or DRG assignment.
• Communicates findings of secondary reviews to Manager.
• Collaborates with CDI Educator/Auditor when educational needs are identified from second level reviews.
• Researches, investigates and remains up to date on both clinical and coding guidelines in quarterly Coding Clinics as they relate to physician documentation improvement needed, in an ICD-10 coding environment.
• Assists in overall quality, timeliness and completeness of the quality health record to ensure appropriate data, provider communication, and quality outcomes.
• Serves as a resource for appropriate clinical documentation.
• Documents and tracks second level reviews and results; shares this information with Manager.
• Collaborates with physicians and/or other clinicians to enhance understanding of the CDI program goals; ensures the medical record can be coded accurately in order to accurately reflect patient severity of illness and risk of mortality.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.
• Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.
• Other duties as assigned.
• Together, we’re creating an environment where exceptional care can flourish.
• It starts with you.