CDI Educator​/Auditor, Fu-Time

Inspire health. Serve with compassion. Be the difference.

Job Summary

The Clinical Documentation Integrity (CDI) Educator/DRG Auditor role involves reviewing inpatient medical records to identify documentation opportunities to accurately represent the severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics. Monitors internal key indicator metrics associated with CDI as it related to the revenue cycle and quality outcomes. Strategically audits cases in regard to Denial Prevention, Quality comorbidities, Risk Adjustment related data audits, and Quality Assurance audits.

Facilitates improvement in overall quality, completeness, and accuracy of the medical record documentation through extensive audit investigation and data analysis. Based on findings from audits, the CDI Educator/DRG Auditor will provide system wide education and training to CDI team, Coding team, medical providers, and other healthcare teams on effective and compliant clinical documentation. The education is to be provided both in formal and informal settings, on an individual and group basis.

The education tools to be used should include, but are not limited to, power point presentations, newsletters, and documentation tip sheets. The educator will work closely with both CDI and Coding leadership to identify educational opportunities for all members of the healthcare team responsible for medical record documentation. Acts as consultant and educator to providers, CDI, and coding staff relative to clinical documentation and coding.

Assists with denial management as it relates to documentation. Assists with audit findings from third-party vendors to identify areas of opportunities. Demonstrates proficiency on ICD
10-CM & PCS and respective coding guidelines & regulations for coding and reporting. Matter expert of key CDI hospital quality metrics (PSI, HACs, Vizient and Elixhauser Comorbidities, etc.) and Inpatient Prospective Payment System (IPPS) documentation requirements for proper APR & MS DRGs assignment. Auditor functions at a higher level by leading and supporting the CDI team; and by active participation in physician/clinical staff engagement and education.

Communication skills, both verbal and written will be necessary to facilitate teaching/training. Analytical skills necessary to assist CDI manager with data analysis and reporting.

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:
  Inspire health. Serve with compassion. Be the difference.
• Performs quantitative and qualitative analysis of health records and physician queries to ensure coding documentation is accurate, consistent, and complete. Reviews inpatient medical records to ensure documentation accurately represents the severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics.
• Utilizes critical thinking and expertise to conduct chart reviews based on DRGs and analyze audit results to identify gaps in documentation. Uses patterns/trends to provide training opportunities for both providers and CDI team. Assists with audit findings from third-party vendors to identify areas of opportunities.
• Mentors and educates team to meet and maintain goals and expectations. Creates and provides large group educational sessions for team, coding team, and providers. The education is to be provided both in formal and informal settings, on an individual and group basis. The education tools to be used should include, but are not limited to, power point presentations, newsletters, and documentation tip sheets.
  
  The educator will work closely with both CDI and Coding leadership to identify educational opportunities for all members of the healthcare team responsible for medical record documentation.
• Based on findings from audits, the CDI Educator/DRG Auditor will provide system wide education and training to CDI team, Coding team, medical providers, and other healthcare teams on effective and compliant clinical documentation. The education is to be provided both in formal and informal settings, on an individual and group basis. The education tools to be used should include, but are not limited to, power point presentations, newsletters, and documentation tip sheets.
• Works closely with both CDI and Coding leadership to identify educational opportunities for all members of the healthcare team responsible for medical record documentation. Acts as consultant and educator to providers, CDI, and coding.
• Provides individual education and feedback to team members based on DRG audit findings (including but not limited to opportunities related to improvement in chart reviews, coding practices, and query writing). Reports findings and recommendations to CDI program leadership to assist with team member audits, coaching, and/or action plans when improved opportunities are identified.
• Collaborates with leadership to plan, develop, and implement…