- Medical Coding Certification
- Medical Terminology
- Medical Records
Navigant Business Process Management unites the strengths of four category-leading companies to address the complexities of today’s healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.
The Remote Clinical Documentation Integrity (CDI) Specialist is responsible for conducting concurrent inpatient chart reviews on assigned units to ensure documentation is complete and accurate at the time of discharge to properly reflect the severity of illness and resources consumed for timely, accurate and compliant coding. Initiates queries in a professional, non-leading manner to clarify ambiguous or conflicting documentation, obtain specificity of diagnoses, and connect treatment performed to a diagnosis (if known). Performs coding, working DRG assignment and enters all review activity into tracking software. Perform any and all related job duties as assigned. This is a 100% remote position that requires some work on weekends.
Must have strong organizational skills
Must be a Team Player that is able to work independently
Have the ability to interact directly with Physicians
Be proficient with technology
Have effective verbal and written communication skills
Must have ability to accommodate flexibility in work schedule based on physician rounding timeframe
Conducts daily, concurrent review of inpatient records on assigned unit(s), to ensure complete and accurate physician and or clinician documentation is present at the time of discharge for accurate, timely, and compliant coding.
Reviews daily admissions to assigned unit, performs initial code assignment for a working DRG and completes CDI software data entry for initial and follow up case reviews (or worksheet to include code and DRG assignment, and submits to Program Assistant daily).
Updates “working DRG” as documentation supports or physician query answer supports a change in the DRG assignment.
Communicates to the CDI Coordinator when volume of daily review assignments is too high or low so that CDI Coordinator can assist in adjusting review assignments amongst the team.
Initiates compliant physician queries when documentation is confusing, ambiguous or missing and follows up with MD to seek immediate response to query (utilizing the following AHIMA practice briefs as a guide: “Managing an Effective Query Process”, October 2008 and “Guidance for Clinical Documentation Improvement Programs”, May 2010).
Ensures the query verbiage is in no way leading or suggestive in tone and is supported by the documentation in the record to include clinical indications and treatment provided.
Performs follow up on incomplete physician queries to obtain an answer while the patient is still in-house.
Analyzes complete clinical documentation from a compliance, coding and/or reimbursement perspective including rationale for the initiation, discontinuation and/or adjustment of treatment modalities utilized in the care of the patient.
Assures physician has sufficient documentation for corresponding diagnosis of all monitored, evaluated or treated illnesses and initiates queries as appropriate.
Ability to identify possible documentation risk areas, including missing orders, patient identification, legibility issues and poor documentation trends.
Provides daily feedback and education to physicians on the quality of documentation and presents examples of how physician documentation can improve compliance based on CMS guidelines.
Promotes accurate DRG classification according to standards set forth by CMS (Center for Medicare & Medicaid Services) to reduce documentation-related-risks associated with DRG-based payers.
Assures record reflects the patient’s severity of illness and risk of mortality (ROM) to improve accuracy of hospital case mix index, national comparisons and physician profiles.
Possess a clear understanding of MS DRG guidelines and required documentation components for accurate code/DRG assignment.
Keeps abreast of Coding Clinic updates, to include code changes, MCC and CC changes and/or changes in the DRG system to effectively educate DI team and physician and clinical team members regarding changes.
Keeps abreast of Recovery Audit Contractor (RAC) review activity to avoid potential risk for the facility.
Assist in developing reports as needed for the review and analysis of facility specific documentation and reimbursement patterns.
Assist in development of physician and/or clinician education.
Provides accurate and up-to-date information on regulatory and reimbursement requirements.
Works closely with case management, physicians, clinicians, and departments to improve communication regarding documentation and reimbursement issues.
Investigates and responds timely to questions regarding documentation or coding issues.
Educates physicians, clinicians, and departments on documentation, coding, and reimbursement guidelines and facilitates understanding of payer and regulatory requirements.
Attends scheduled physician education/training sessions on clinical units and/or MD offices as requested on a daily and/or weekly basis.
Build trustworthy and strong relationship with client staff, physician base and Navigant Cymetrix staff.
Stays current on documentation & billing requirements to ensure compliance with all regulatory and governmental agencies.
Observes confidentiality and safeguards all patient-related information.
Serves as a role model for all co-workers by setting an example of high standards in dress, conduct, cooperation and job performance.
Meets or exceeds established quality and productivity standards.
Check e-mail system at a minimum of three times per day: beginning, middle, and end of working day.
Assists with coding backlogs and performs other duties as assigned.
Must have one of the following certifications or licenses: RHIA, RHIT, CCS, RN, LPN, LVN.
Must maintain credential while employed.
Requires at least 3 years acute care hospital medical records or medical coding experience.
Familiarity with Encoder preferred and DRG assignment.
Strong clinical understanding of disease process.
Maintains current working knowledge of Coding Clinic Guidelines and federal updates to MS DRG system.
Knowledge of medical terminology, anatomy, physiology, microbiology, and disease processes.
Excellent communication skills, employing tact and effectiveness.
Ability to converse with physicians in sometimes difficult scenarios.
RN’s- 5 years inpatient clinical, case management and management experience and ability to perform code assignment/corresponding DRG assignment in facility encoder preferred.
Coders- previous inpatient record review experience preferred.
Frequently communicates with clients and coworkers and must be able to share information effectively
Strong conceptual, as well as quantitative and qualitative analytical skills
Work as a member of a team as well as be a self-motivator with ability to work independently
Flexibility and responsiveness in managing multiple projects in sometimes high-pressure situations simultaneously
Usually remains stationary for the majority of the day
Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
Navigant is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information or any other basis protected by law, ordinance, or regulation.
Navigant will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.