The CDI Coding Specialist uses clinical knowledge to serve as an advisor to providers and staff regarding complete and accurate documentation supporting services provided in the office based setting. The CDI Consultant will conduct concurrent reviews of outpatient medical records after the patient is seen as well as work with clinicians concurrently to guide and educate. This position collaborates with providers and coding teams to deliver education on documentation best practices that result in accurate, comprehensive medical record that reflects the diagnoses for the patient and supports patient care and correct reimbursement.
Project Details:
Perform retrospective chart reviews for improving the overall completeness of clinical documentation
Collaborate with physician to identify and clarify missing, conflicting or nonspecific documentation related to diagnoses and procedures
Communicate with clinicians to clarify documentation and query for specificity
Monitor verbal and written queries
Acts as a resource for Providers and Coding staff
Keep abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI current trends
Effectively utilizes ICD, CPT/HCPCS and related materials to investigate coding issues and produce accurate results
Serve as an expert resource in reviewing all medical records in support of accurate documentation for all payer types to assure complete and accurate diagnosis and procedure capture and coding
Proactively coordinate and engage regular meetings with HIM Coding, Physician champions and Leadership
Lead and execute physician education strategies that result in improved clinical documentation and complete capture of diagnosis coding
Contribute to the overall development and maintenance of the Medicare Advantage internal share point site and related reference materials
Supports monitor, and report key performance indicators (KPIs) to Senior Management
Monitor trends in the CDI process and develops and implement action plans to maximize the program
Develop and implement CDI strategies, provide analysis and make recommendation for process improvement
Collaborate with staff within other functional areas
Develop monitoring tools to track progress of CDI program such as identification of cases with CDI opportunities, HCC recapture rate, etc.
Maintain expert knowledge of CDI and ICD-10 Coding
Keep abreast of current changes in coding and reimbursement requirements for government programs and other third party payers
Review Medicare and Commercial payer publications on a frequent basis and develops coding education in a proactive fashion to add value to the overall quality of clinical documentation
Actively participate in meetings and/or seminars and disseminate the information to peers to enhance the knowledge and skills of the department
Other duties as assigned
Job Experience:
Minimum five (5) years of experience in either clinical nursing, case management, Inpatient Coding, Utilization Review, Physician Assistant or other clinical disciplines with either coding or CDI experience or an equivalent combination of these disciplines.
Bachelor's Degree in Nursing, Physician Assistant or other clinical heath care related field required.
Current license, certification or professional licensing in field of expertise required.
Familiarity with Windows based software programs and basic computer skills
Knowledge of health record content and sequence.
Knowledge of JCAHO requirements and federal and state guidelines applicable to health record completeness and patient privacy.
Oxford is an Equal Employment Opportunity Employer. All qualified applications will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Oxford will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. Oxford provides supplemental medical (we do not offer major medical), dental, vision, life, and disability benefit plans along with a 401(k) Retirement Savings Plan. Paid holidays based on eligibility and paid sick leave for applicable jurisdiction, as required. Oxford is committed to working with and providing reasonable accommodation to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please email oxfordbenefitsgroup@oxfordcorp.com. We will make a determination on your request for reasonable accommodation on a case-by-case basis.