The Manager serves as a team leader and facilitator for the Clinical Documentation and Coding Integrity program (CDCI) and Clinical Nurse Auditor for patients with DRG and Insurance based payers. Ensures reviews of the patient’s medical data are conducted to assess appropriateness and medical necessity for admission, and continued stay. Facilitate improvement in the overall quality, completeness, and accuracy of medical record documentation.
- Facilitates coordination, prioritization, and collaboration of staff, and actively participates in the concurrent documentation processes to meet departmental needs and accurate documentation.
- Interacts effectively with physicians regarding documentation appropriate to diagnosis and severity of illness.
- Participates as an active member of the documentation work group, assist with special projects as needed and performs related duties as assigned.
- Manages CDIS, and Clinical Nurse Auditor personnel and activities. Develops processes and tools for use by CDIS, and Clinical Nurse Auditor personnel. Leads routine CDCI Task Force meetings with CDIS, Auditing and coding personnel.
- Develops and monitors CDCI metrics to assess the impact of and performance opportunities for CDCI initiatives.
- Collaborates with other disciplines regarding proposed DRG changes and proposed quality concerns when requested; communicate with the attending physician or medical director regarding these issues as appropriate.
- Develops educational and training materials for physician advisor and medical staff, to promote an understanding of and participate with the CDCI initiatives.
- Participates in coding appeal process with HIM Coding Manager and PFS staff as requested.
- Responsible for achieving Cheyenne Regional’s standards for customer service.
- Responsible for achieving budget targets.
- Responsible for employee selection, orientation, training/development, performance reviews, disciplinary action and work assignments.
- Collaborates with coding staff to ensure that the clinical information used in measuring and reporting outcomes is complete and accurate.
- Provides operational leadership and has budget responsibilities.
- Adheres to established leadership competencies, service standards and reinforces excellence in those standards with subordinates.
The above statements are intended to describe the general nature and level of work performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified and employees may be required to perform other duties as assigned.
SKILLS, KNOWLEDGE, AND ABILITIES
- Must possess a high level of clinical knowledge regarding the patient population served in order to participate collaboratively with all members of the care team.
- Must demonstrate knowledge of disease definitions and natural history, possess the ability to assess data reflective of the patient’s clinical status, interpret the appropriate information needed to identify each patient’s acuity and severity of illness
- Demonstrates ability to use technology and appropriate software to support their daily activities.
- Organizational skills with the ability to communicate effectively with all levels of professions, including but not limited to physicians and nursing personnel, managers, and various support staff departments, and third party payors in a non-confrontational manner
- Strong critical thinking skills and ability to integrate knowledge
- Possess the following; critical analysis skills; ability to resolve complaints/problems; customer focused philosophy of service delivery; ability and willingness to work as an integral member of a multi-disciplinary team, computer literacy
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