CDI Reviewer

Summary:

The CDI Second Level Reviewer reports to the Manager of the Clinical Documentation Integrity Department. Under general supervision and within Brown University Health established policies, the CDI Second Level Reviewer Provides auditing of various CDI metrics and as necessary training to CDI staff, medical providers, and ancillary staff on related effective and compliant clinical documentation. By completing required departmental, staff and facility wide audits the CDI Second Level Reviewer facilitates consistent, accurate, optimal documentation by collaborating with CDI management, CDI Educator, Coding Leadership and the CDI Physician Advisor and outside organizations as needed with goal of always obtaining accurate, reliable, and timely data that supports the educational development and goals of the CDI department.

Responsibilities:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

The CDI Second Level Reviewer will develop, implement, coordinate, and maintain a network-wide formal CDI Auditing program and schedule. These audits will include but may not be limited to query audits, case audits, and review of high risk DRGs. In addition, the Second Level Reviewer may responsible to respond to Appeals from insurers. The audits will be carried out in a timely manner with identification of areas of education and follow up needed. The Second Level Reviewer will work closely with the CDI Educator and CDI Management to identify and prioritize the areas focus. Plans will be updated as Coding guidelines, CDI practices, Coding Clinics and environmental impacts affect CDI workflow. Coordination and collaboration with the Data Analyst for report gathering will be communicated and completed as needed in the delivery of auditing data and educational opportunities to the staff and providers. Auditing results also will be at times offered to the Coding department as part of a collaborative, collective means to be sure all HIM documentation is optimal per standards. The Second Level Reviewer will be involved in updating of various educational tools and may include, but are not limited to, power point presentations, newsletters, and documentation tips sheets.

The Second Level Reviewer will demonstrate enhanced knowledge, or ability to abstract the necessary information related to anatomy and pathophysiology to facilitate the increased need for granularity and specificity within clinical documentation that coincides with advance query opportunities and then will be able to audit for related topics. Improves the overall quality and completeness of clinical documentation through the application of evidence-based knowledge, analysis, in-depth review, interpretation, identification of opportunities, communication, consistent follow-up, and evaluation of concurrent and retrospective (as required) medical record documentation.

Provides feedback and data on all auditing completed to CDI Management and keeps organized records. Has ability to acts as a resource to the clinical providers on optimal clinical documentation. Will work under direction and in collaboration of CDI management and our CDI Physician Advisor on Audit results presentations, memos, etc. to Brown University Health LIPs of all levels as needed.

The CDI Second Level reviewer will be able to effectively communicate and demonstrate the enhancements made to our software systems such as, but not limited to 3M, EPIC, SMART and Vizient as needed. Will work with the CDI Educator as a needed and will be resource when programs are updated.

Designs and delivers presentations in a very concise, organized fashion. Manages assigned aspects of projects directly or through departmental Administrative Assistant to include, but not limited to distribution of data to required customers with follow-up communications as needed. Ensures the accuracy, validity, and timeliness of all work. Proactively evaluates all educational products for relevancy to our work and can identify needed education through the analysis of audit results and other department metrics. Provides resources and outcomes on requested schedules to CDI management.

Continued ability to perform standard CDI reviews as needed in occasional circumstances. Ability to cover for CDI Educator as needed.

Performs other related duties as needed.

Other information:

Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing.

EDUCATION

RN with BSN and CCDS required.

Master's degree in Nursing, Public Health, Healthcare Administration,
Business, or a similar field is preferred.

EXPERIENCE:

Five to seven years as a CDI with expert ability in Coding guidelines,
MS-DRG/APR-DRG's, IPPS including new CMS guidelines, CDI practices, and medical
knowledge. Strong auditing skills, systems-thinking, project management, and
facilitation skills aimed at performance improvement of our CDI staff and
providers. High level of interpersonal
and communications skills to effectively consult with all levels of leadership,
management, and non-management employees. Ability to work collaboratively and independently in a fast-paced
environment. Advanced skills with EPIC, 3 M and SMART database management as
needed. Proficient skills in Microsoft
Office, i.e., Word, Excel, Access, PowerPoint. Experience in group
facilitation, project management, and providing training and instruction to
users at all levels is required.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Work is performed in a typical office setting, requiring extensive
periods of sitting, with arms extended as well as walking and standing. Incumbent is required to have the ability to:
read and comprehend medical record documentation, lift a minimum of 25 pounds,
bend, stoop, and stretch, sit for prolonged periods using a computer, mouse and
reading from a computer monitor required.

Work from home capabilities are available upon CDI Management approval.
The Clinical Documentation Department has a partial remote work schedule with
up to 3 days at home and 2 days in the office. Remote work schedule may
increase or decrease due to administrative and organizational situations,
i.e.: educational training, local or
global crisis.

All roles and responsibilities and compliance standards will be
maintained whether in office or virtual.

INDEPENDENT ACTION:

Incumbent generally establishes own work plans and priorities, including
the development and utilization of appropriate analytic strategies, educational
methodologies, and activities to assure accurate, valid, and timely completion
of work in conformance with organizational and department policies and
practices. Position requires self-directed, independent decision-making,
analytical teaching, and articulate communication skills, both verbal and
written.

SUPERVISORY RESPONSIBILITY:

None.

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services, USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union