CDI Validation Specialist

Position Summary

The CDI Validation Specialist assists the CDI Manager with oversight, evaluation, and analysis of CDI functions including efficiency, accuracy, continuing education needs, and overall quality. This individual identifies education needs of Clinical Documentation Specialists and collaborates with CDI Manager, IP Coding Manager, and IP Coding Validation Manager to develop appropriate training materials. The primary goal is to ensure the documentation in the chart identifies all clinical findings, diagnoses, and procedures, and is appropriately and clinically supported.

The CDI Validation Specialist will work with the CDI Manager to leverage performance, providing feedback and influencing continual improvement of documentation results, thereby impacting key performance indicators.

• Monitors CDI staff accuracy, data quality and integrity.
• Monitors CDS review process for content, timeliness and accurate diagnosis and procedure assignment in determining a working DRG.
• Monitors concurrent queries for compliance, accuracy, clarity, and timeliness.
• Audits clinical documentation specialists retrospectively to assess for completion of chart review and query compliance including missed query opportunities, accurate coding, and adherence to AHIMA/ACDIS compliant query guidelines/standards.
• Collaborates with CDI manager to identify, coordinate, and implement CDI specialist ongoing education and feedback based on identified opportunities for improvement via auditing.
• Assists in orientation and training of new clinical documentation specialists.
• Reviews and analyzes denial claims and denial data to provide support in denial prevention strategies via clinical validation query process and education to CDI specialists.
• Contributes to departmental and organizational quality performance goals, including auditing mortality and readmission cohorts to identify opportunities for improvement. Coordinate and implement CDI specialist education based on identified opportunities.
• Collaborates with CDI manager to create and update documentation tools, processes, procedures, and workflows on an ongoing and as needed basis.
• Reviews charts concurrently with no MCC/CCs, low SOI/ROMs and LOS not supported by working DRG.
• Identifies and educates CDI with missed query opportunities.
• Assists CDI manager with final DRG validation when there is a discrepancy between CDS and coder.
• Collates information for final DRG validation when there is a discrepancy between CDS and coder.
• Collaborates with the CDI Manager and identifies opportunities for performance improvement activities on processes.
• Collaborates with CDI Manager, IP Coding Manager, and IP Coding Validation Manager to strategize appropriate training methodology for individual issues.
• Provides timely appropriate feedback to CDI Manager on any performance improvement plans for CDI staff.
• Collaborates with other CDI department managers to identify areas for improvement and solutions for process improvement.
• Assures documentation is compliant with federal and state regulations, coding guidelines and hospital policies.
• Remains up-to-date in clinical and coding/documentation-related materials, including CDS best practices as defined by ACDIS and ICD-10-CM/PCS, AHA Coding Clinic guidelines for coding and reporting and MS-DRG/APR-DRG classification systems.
• Monitors regulatory and reimbursement changes.
• Serves as resource for CDI informational needs and updates CDI on coding changes, medical science and CDI practice standards.
• Provides guidance, support and expertise to the CDI specialists.
• Tracks trends in documentation concerns and implementing solutions for improvement.
• Uses leadership and critical thinking skills to identify opportunities for team processes and engagement.
• Recommends solutions for improvement when deficiencies are identified.
• Provides CDI specialists, coders, and coding validation specialists with clinical feedback to assist accurately capture diagnoses and/or opportunities for querying physicians post discharge for additional information.
• Evaluates the success of concurrent documentation improvement on an ongoing basis.
• Advances professional growth and development through participation in educational programs and workshops and maintaining knowledge of industry standards and practices.
• Assists manager, when requested, in the development of APR/DRG/query response physician reports. Maintains complete confidentiality of patient information in addition to hospital and individual physician practice pattern data.
• Assumes operational oversight of CDI department in the absence of the CDI manager.
• Adheres to all BMC’s RESPECT behavioral standards.
• Other duties as assigned.

• Bachelor’s degree (or equivalent) in nursing, health information management or related field and at least five (5) years experience in clinical documentation, or equivalent combination of education and experience, required.