Lead Clinical Documentation Improvement Specialist (CDIS) - Seneca Holdings

Great Hill Solutions is currently seeking a Lead Clinical Documentation Improvement Specialist (CDIS) to support our Defense Health client on-site in the Northern Virginia Area. This critical member of the healthcare team will support coding compliance and data quality operations as part of the) Coding, Training and Compliance (CTC) team under the Patient Administration Department (PAD). The CDIS team will use their clinical and coding expertise to educate providers on the quality of their documentation resulting in improved patient care and better outcomes. The Lead Clinical Documentation Improvement Specialist will use his/her documentation expertise to build an accurate clinical picture of the severity of illness for the patient, assess quality measures, and when necessary, query providers for clarification. Furthermore, team members will build rapport with clinical providers and provide expertise on documentation while also working with hospital coders to ensure accuracy of patient records.   

Responsibilities include, but are not limited to:

• Analyze and review medical records to ensure accurate diagnosis information according to international classification standards.
• Review patient records to identify missing or potentially inaccurate coding and modify coding as appropriate.
• Ensure medical coding practices that support the diagnoses and service reported.
• Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external.
• Interacts with staff to ensure documentation is clear and supports coding assignments. Educates staff through individual or group in-services and training sessions.
• Conduct internal audits and monitor coding practices and documentation deficiencies by clinics/providers in order to maximize data quality, coding timeliness, coding accuracy, and workload capture for the MTF.
• Develop clinical documentation improvement training for clinics/providers in order to maximize workload capture for services provided, and to improve data quality metrics and coding compliance/timeliness statistics for the military treatment facility.
• Work with Coding Compliance-Editor (CCE) software to ensure records are accurately coded.

Basic Qualifications and Skills:

• Knowledge of The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-CM) codes, procedural coding, healthcare common procedure coding system (HCPCS)/current procedural terminology (CPT) nomenclature, medical and procedural terminology, anatomy and physiology, pharmacology, and disease processes to perform the duties described. Knowledge of reimbursement systems, including the Knowledgeable- Integrated Resourcing and Incentive System (IRIS); Prospective Payment System (PPS) and Diagnostic Related Groupings (DRG); Ambulatory Payment Classifications (APCs); and Resource Based Relative Value Scale (RBRVS).
• Knowledge of and the ability to interpret guidelines, rules and regulations developed by: Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Heart Association (AHA), Military Health System (MHS) Coding Guidelines, and other applicable Federal requirements to provide timely and accurate information relating to coding, billing and documentation.
• Excellent oral and written communication skills. The successful applicant will have excellent interpersonal skills along with the confidence to present complex medical coding issues and educational instruction to a diverse audience of medical professionals. Must be comfortable in front of high ranking, professional staff, and coding peers to provide training and respond to questions.
• Ability to write reports, business correspondence, and procedure manuals.
• Organizational, analytical, time management, statistical, and problem-solving skills.
• Advanced knowledge of computers, keyboard skills, and various software programs including Microsoft (word processing, spreadsheet and database) as well as coding software programs such as the Coding Compliance Editor (CCE).
• Must possess ability to pass security clearance or have a current National Agency Check with Local Agency Check and Credit Check (NACLC).
• The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting, or bending. Carrying or lifting of medical records may be required daily. Use of one or more computer programs and monitors simultaneously is typical and frequent. Routine travel between the Hub facility and the assigned remote sites is required.
• The position is required to be on-site.

Required Education: 

• Must have at least one of the recognized certifications: Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coder Specialist (CCS), Certified Coder Specialist – Physician (CCS-P) are preferred for outpatient/ambulatory surgery medical coders as long as candidate has a minimum of ten years of experience in the outpatient setting (physician's office or ambulatory care centers) within the last five years.

Required Experience: 

• A minimum of five years of experience in the outpatient setting (ambulatory care centers) within the last seven years is required or a minimum of two years if that experience was in a military treatment facility. Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor.
• Candidates will require a minimum of five years of medical coding experience in production coding environments within the past seven years, in more than four medical and surgical specialties, involving assignment of ICD, E&M, CPT, and HCPCS codes.
• Coding, auditing and training for ancillary services such as physical, occupational therapy, speech, and nutritional medicine as well as home health, skilled nursing facilities, rehabilitation care and urgent care clinics are not qualifying factors.

AND

• A minimum of four years of auditing, training, and/or compliance functions within the last eight years is required in at least four medical and surgical specialties.

OR

• Candidates with three years of auditing, compliance, or training experience involving professional coding within the last five years in a DoD coding environment may be considered in lieu of 10 years for those without DoD experience. Auditing, compliance, or training experience is described as:
• Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation and determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.
• Training functions include identifying coding training opportunities, developing coding training plans, and development/delivery of coding training to coder and physician/provider audiences.
• Compliance functions include identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures; recommending/updating standard policies and procedures; contribute to risk assessments and mitigation strategies; and data collection and statistical report generation.

Desired Qualifications:

• A bachelor's degree in a clinical field is preferred.
• A previous background in clinical care is preferred.
• Previous experience providing documentation training to clinical providers is preferred.
• Previous experience with MHS Genesis or experience in the Military Health System is preferred but not required.