Job Description
JOB SUMMARY:
Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which impacts Case Mix Index and mortality ratings. Coordinates with physicians, nurses, ancillary staff, and the coders in Health Information Management to identify and record principal and secondary diagnoses, principal procedures, and assign the working DRG. Performs second level review of specific DRGs as assigned. Presents education related to CDI topics to peers and providers we needed or requested. Reviews DRG denials and provides information to the denials team related to appealing the encounter
EDUCATIONAL REQUIREMENTS Associate's Degree in Nursing or Doctorate
CERTIFICATION & LICENSURE REQUIREMENTS Registered Nurse (RN) Illinois or Registered Health Information Administrator (RHIA)
EXPERIENCE REQUIREMENTS At least two (2) years Clinical bedside experience and Two (2) years CDI experience
Medical Graduate with clinical practice as a physician in an acute care setting if degree is Doctorate
SKILLS AND KNOWLEDGE Requires excellent organizational and communication skills. Demonstrated ability to work as an active member. Up to date clinical skills preferred; need to have current working knowledge of pathology, managed care, healthcare quality, and reimbursement. Excellent computer skills, including knowledge of word, excel and power point.
ESSENTIAL FUNCTIONS:
- Conducts the initial concurrent review process for all selected admissions.
- Clarifies documentation in the medical record as appropriate through communication with the physicians, nurses, and ancillary staff. Assures documentation in chart represents a true clinical picture of the patient diagnoses and supports care that was given and DRG assigned.
- Documents findings within Carle CDI software and updates software as required to reflect status of the encounter and any follow up.
- Coordinates with the physicians, nurses, ancillary hospital staff, and Health Information Management Department's coding staff to identify and record principal and secondary diagnoses, principal procedures, and assign the working DRG.
- Follows query process and escalates as necessary.
- Conducts education related to CDI topics to peers and providers as needed or requested.
- Performs second level review on selected inpatient encounters.
- Reviews denials for accurate and complete documentation and develops appeal letter when needed.
- Attends mandatory and regular education sessions as needed.
- Follows appropriate workflow in EPIC and CDI software and notifies one up leader of any issues.
- May serve as an "expert" and participate in testing for upgrades as needed.
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