Clinical Documentation Integrity Educator - Dept of Pediatrics

Boston Children’s Hospital; Boston (MA); Hybrid; USD 60,000 - 90,000; Full time

Job summary

An established industry player seeks a Clinical Documentation Integrity Educator to enhance the quality of clinical documentation within the Department of Pediatrics. This role involves leading educational initiatives, collaborating with healthcare providers to ensure accurate coding, and analyzing clinical information to identify gaps. The ideal candidate will have a strong clinical background and be adept at developing training programs. Join a forward-thinking organization that values accuracy and quality in patient care, offering a hybrid work schedule that balances on-site and remote work. This is a unique opportunity to make a significant impact in a vital area of healthcare.

Qualifications

• Licensed Clinician with experience in clinical documentation and coding.
• CPT coding certification required or willingness to obtain.

Responsibilities

• Lead internal staff education on clinical documentation.
• Develop and deliver coding education programs for staff and providers.
• Collaborate with coding and compliance teams to manage documentation.

Skills

ICD-10-CM coding

CPT coding

Clinical documentation

Trend analysis

Education program development

Collaboration

Education

Bachelor's degree

Licensed Clinician (LPN, RN, PT, OT, Speech-Language Pathologist, Pharmacist)

CPT coding certification

Tools

Data collection software

Job description

Job Title: Clinical Documentation Integrity Educator

The Clinical Documentation Integrity Educator is responsible for:

1. Serving as the lead for internal staff education within the Department of Pediatrics, developing prescriber education, executing trend analysis to support department initiatives, and facilitating improvements in the quality and completeness of provider-based clinical documentation to ensure accurate reflection of services and acuity in the medical record.
2. Supporting appropriate clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and external coding companies to ensure proper reimbursement and complete, accurate clinical information for profiling and reporting.
3. Developing and delivering coding education programs for providers, staff, and new hires.
4. Ensuring all clinical treatments, decisions, diagnoses, and coding accurately reflect patient care.
5. Providing orientation on coding, audit processes, and documentation standards.
6. Answering coding and compliance questions from providers and staff.
7. Serving as a resource for physicians to link ICD-10-CM coding guidelines and medical technology to improve code accuracy.
8. Querying physicians concurrently and utilizing software systems to collect, track, and report outcomes.
9. Maintaining data integrity in collection processes.
10. Collaborating with external coding staff to promote complete and accurate documentation and to address negative trends, leading advanced projects to improve documentation practices.
11. Participating in departmental and organizational projects related to clinical documentation.
12. Serving as the primary contact for staff workflows and education, including managing orientations, updating training materials, conducting audits, and monitoring industry practices and ICD code updates. Initiating and performing documentation reviews to clarify conditions/diagnoses where documentation is inadequate or conflicting.
13. Analyzing clinical information to identify potential gaps in physician documentation.
14. Collaborating with hospital compliance and coding/billing teams to manage clinical validation denials.
15. Working on appeal processes and trend assessments to support proactive improvements, and creating training programs for prescribers to enhance documentation.
16. Identifying trends, variances, and deficiencies using data to support leadership proposals and targeted education.
17. Working 40 hours per week, Monday through Friday, with a hybrid/remote schedule approximately 2-3 days on-site, subject to operational needs.

Qualifications for the Clinical Documentation Integrity Educator:

1. Licensed Clinician, including LPN, RN, PT, OT, Speech-Language Pathologist, or Pharmacist.
2. Bachelor's degree or equivalent work experience.
3. CPT coding certification required or willingness to obtain certification within 6 months of hire.
4. Minimum of 3 years recent, broad-based clinical experience, preferably in both inpatient and outpatient settings.
5. At least 2 years of clinical chart review experience applying ICD coding knowledge to medical records.