Clinical Documentation Integrity Specialist

Overview

Clinical Documentation Integrity Specialist

Full Time, 80 Hours Per Pay Period, Day Shifts

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

Position Summary:

The CDI Specialist serves as a liaison between the physicians and hospital departments to promote consistency and efficiency in documentation and to facilitate data quality and compliance in hospital services. CDI is responsible for facilitating concurrent documentation reviews in the setting of an acute care facility. Concurrent reviews assure the completeness of medical records, the accuracy of documentation, and the appropriate assignment of a final DRG. The CDI Specialist functions as a resource for clinical staff and other groups involved in the care and discharge planning of patients. To assure appropriate DRG assignment and the validity and reliability of the case-mix index, CDI is accountable for concurrent review of health records, reviewing documentation that supports the severity of the patient’s condition, and the resources used in the diagnosis and treatment of the patient. The validation of the clinical diagnoses is an additional focus and responsibility.

Responsibilities

• Initiates and performs concurrent documentation reviews to assign initial DRGs and GLMOS for physician and case management to follow.
• Collaborates extensively with individual physicians and other medical and clinical staff departments to facilitate complete and accurate documentation of the inpatient record.
• Monitors inpatient admissions for Length of Stay (LOS) related to initial DRGs and updates to working DRGs and SOI/ROM for final coding and DRG assignment.
• Prepares reports for any assigned facilities. Assists with the collection and maintenance of data that reflects the productivity and effectiveness of all CDI actions related to individual chart reviews, queries, response to queries, and communication and education with physicians.
• Understands HACs, PSI, and POA issues as it relates to quality measures.
• Serves as a resource for physicians to help link ICD-10-CM and ICD-10-PCS coding guidelines and medical terminology to improve accuracy of final code assignment.
• Works in a collaborative fashion with Health Information Management and Coding Departments to assure that initial and final DRGs are correct.
• Assigns concurrent queries when required to assure that documentation is consistent and that diagnoses meet clinical definitions.
• Assists the HIM Department with post discharge queries as needed.
• Assesses documentation to assure that risk measures accurately reflect the severity and risk involved in patient’s care.
• Educates and assists physicians and clarifies coding versus clinical issues.
• Identifies opportunities for intradepartmental and interdepartmental operational improvements.
• Remains informed about annual changes pertinent to ICD-10-CM/PCS, follows through with educating appropriate parties, and applies information to concurrent reviews as needed.
• Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.
• Monitors activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported.
• Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.
• Increases awareness of compliance as it relates to coding and documentation.
• Applies knowledge related to proper documentation necessary to support MS-DRGs/APR DRGs/Medical Necessity/ROM/SOI assignment.
• Reconciles discharge and coded records to assure that queries have been answered and results are correctly assigned.
• Keeps current on local, state, and federal regulations to ensure compliance.
• Keeps current on coding guidelines and communicates to Health Information Manager. Implements corrective actions as indicated to minimize financial risk.
• Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.
• Ensures corrective action is taken to prevent denials from recurring.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:           

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority. Graduate from an accredited HIM program preferred.

Minimum Experience:         

Four (4) years coding experience or relevant work with health systems either in acute care or outpatient settings. Effective interpersonal skills in order to interact effectively with all levels of hospital personnel. Organization and prioritization skills. Effective written and verbal communications skills. Analytical skills. Proficient computer skills.

Licensure Requirement:      

RN or equivalent/advanced clinical licensure. RN must be willing to obtain CDI certification within two (2) years of hire date. Employees hired prior to September 2025 may substitute the CDI certification with a CCS certification.