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Clinical Documentation Improvement Coordinator

Summary:

The Clinical Documentation Improvement professionals are exposed to robust institutional and physician support for quality documentation, access to an advanced electronic medical record system and state-of-the-art clinical documentation software. 

Through interaction with physicians, nursing staff, medical records coding staff/compliance specialists and other healthcare providers, clinical documentation analysts facilitate modifications to clinical documentation ensuring accurate depiction of the level of clinical services, reason for admission, patient severity, risk of mortality, severity of illness and conditions present on admission.

Duties:

  • Oversight and management of department operations and personnel.
  • Provides leadership for the operational unit on a daily basis.
  • Ensures monthly metrics are kept on each staff member and determines root cause when metrics are not met.
  • Institutes coaching sessions or corrective action plans as necessary.
  • Establishes and maintains effective working relationships as necessary to promote and support interdepartmental workflow.
  • Interacts regularly with physicians, HIM and other ancillary departments to promote mission and vision of the Clinical Documentation program
  • Communication with Coding Manager and CDI Director of case and resolution
  • Collaboration in planning, analysis, procedure changes, scheduling and related   administrative duties.
  • Assists CDI Director in development of policies and procedures for current practice
  • Directly responsible for all personnel action including, but not limited to, hiring, promotions, retention of staff, vacations, schedules, maintaining payroll records and time reports and terminations.
  • Prepares, documents and conducts all performance evaluations.  
  • Facilitation of issue identification and resolution of team conflict. Monitors initiatives. Effective communication to team and to administration regarding any barriers to success identified within the CDI department
  • Monitoring and reporting of quality and financial performance in collaboration with Strategic Services Associate
  • Maintenance of accurate records of review activities to comply with departmental and regulatory agency guidelines.
  • Participation in the daily work load and function in the role of Clinical Documentation Specialist, if deemed necessary by team staff shortage.

Education and Experience:

  • One of the following is required:
    • Bachelor's Degree in Nursing
    • PA (Physician's Assistant)
    • NP (Nurse Practitioner)
    • Doctorate degree in a medically related field
    • Master's Degree in Nursing or Healthcare (Preferred)
  • 5 years of experience is required that must include 3 years acute care experience and 2 years CDI experience.
  • Recent management or supervisory experience required. 
  • Coding experience or certification is preferred.
  • Experience with utilization management, coding, billing, auditing, and various healthcare payers is preferred.
  • Must be currently licensed as one of the following:
    • RN
    • NP
    • PA
    • Licensure in the specific medical field. CCDS or CDIP or CCS certification highly preferred.
  • ​Excellent communication skills, oral and written.
  • Ability to analyze data, perform multiple tasks and work independently.
  • Must be able to develop and maintain professional,service-oriented working relationships with patients, physicians, co-workers and supervisors.
  • Must be able to understand and comply with policies and procedures.
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