The CDI Specialist ensures accurate physician documentation to support severity of illness and risk of mortality in patient medical records. This involves reviewing records, collaborating with healthcare providers, and partnering with coding professionals to determine final DRG assignments.
Requirements summary
Requires a current RN license and a minimum of five years of acute care nursing experience in medical/surgical, ICU, or ER settings. Candidates must obtain CRCR certification within nine months of hire.
professional certificatePrioritizationInterpersonal CommunicationMedical CodingPatient Care CoordinationMedical Record ReviewAcute Care NursingICD-10-CMICD-10-PCSClinical Documentation ImprovementPhysician InteractionDRG AssignmentDenial Appeal Writing
Job description
Thank you for considering a career at Ensemble Health Partners!
***Must be able to work full time on-site at DKH - Day Kimball Health in Putnam, CT***
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups.
They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy.
We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful.
This is why our people are the most important part of who we are.
By empowering them to challenge the status quo, we know they will be the difference!
Career opportunity offering
Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
This position starts at: $80,000. Final compensation will be determined based on experience.
The Opportunity
The CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate.
Job Responsibilities
Completes initial patient medical record review within 24-48 hours of patient's admission; completes subsequent reviews of patient's medical record reviews every 24-48 hours and enters review findings in CDE software system
Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software.
Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used.
Benefits
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
Bonus Incentives
Paid Certifications
Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record.
Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
Maintains and upholds all clinical documentation regulatory guidelines
Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials.
Experience We Love
Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience
Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills
Minimum Education • Current RN Licensure
Certifications: CRCR Required within 9 months of hire
Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
