The Clinical Documentation Integrity Auditor will perform a variety of chart reviews related to documentation accuracy and specificity, coding accuracy & APRDRG assignment compliance. Analyzes and evaluates patient care documentation after coding and before billing and assigns codes as needed, ensures accuracy of Present on Admission status (POA) and DRGs to validate the documentation supports code specificity per compliance requirements. Performs Pre-bill Audit (PBA) reviews, tracks, trends and reports audit results. Provides feedback & education regarding opportunities for documentation improvement to providers and coders. Provides expertise in ICD coding, DRG assignment, documentation guidance and education, and assists in setting goals and priorities for the coding team. Review payor coding denials for appropriate and accurate coding. Review concurrent admissions and create documentation clarification queries requesting providers to provide additional documentation within the record. Functions as the liaison between the Coding staff, Physician Advisors and Providers. Communicates with and educates Physician Advisors and providers regarding areas of documentation improvement. Reports audit results to appropriate individuals, groups and committees on a monthly or as requested basis. Fosters relationships between all disciplines. Maintains current and thorough knowledge and understanding of clinical documentation improvement, Epic systems, coding schemes, APR-DRG groupers, Cook’s policies, procedures, regulatory requirements and guidelines for documentation, coding and billing/reimbursement.
Education & Experience:
Must have a Bachelor’s degree in Business or Clinical field (i.e. Nursing, Health Information Management, etc.): RHIA or RHIT or RN with CCS required.
Must have a minimum of three (3) years current & continuous acute care hospital inpatient coding and APR/DRG/case mix analysis and a minimum of (1-2) years previous clinical documentation improvement experience with advanced knowledge of current code sets, guidelines and principles required; 1-2 years APR/DRG coding and clinical validation auditing experience in a pediatric setting highly desired.
ICD-10-CM training highly preferred.
Demonstrates superior coding expertise and critical thinking skills with the ability to solve problems appropriately using knowledge and current policies/procedures, guidelines and regulations.
Technically competent and fluent knowledge in navigation of electronic medical record applications, coding decision support tools, including encoders, abstracting & billing systems, electronic medical records (used as coding source documents) and other associated computer applications required.
Proficiency in computer assisted coding/CDI tools, automated coding work flow process and management of coded data integrity highly desired. Experience using Microsoft Office applications (excel, word, outlook, power point) required.
Ability to remain focused, work well independently and productively with minimal guidance and without direct supervision.
Must have sharp analytical and critical thinking skills, must be highly detail oriented, have strong organizational skills, writing, interpersonal and communication skills with ability to maintain confidentiality, create positive relationships; energetic, flexible, goal and team oriented.
Strong verbal and written communication skills.
Ability to give presentations.
Ability to interact with providers and adapt to different communication styles.
Ability to provide excellent customer service routinely in all types of interactions with all individuals.
Demonstrated coding knowledge and proficiency is required with demonstrated ability to easily articulate knowledge of coding guidelines and procedures.
Ability to work independently in a multi-task atmosphere, take initiative, use sound judgement, work with tight deadlines and be flexible, embrace change as this role encompasses a spectrum of highly specialized duties that are only performed by the immediate team members.
Licensure, Registration, and/or Certification:
Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT) with Certified Coding Specialist (CCS) OR Registered Nurse (RN) with Certified Coding Specialist (CCS) required.
Cook Children's Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.