At Houston Methodist, the System Clinical Documentation Improvement (CDI) Quality Reviewer position is responsible for performing internal quality assurance reviews on Clinical Documentation Specialist (CDS) staff to ensure compliance with national guidelines and policies for complete, accurate and consistent reporting which results in appropriate reimbursement and data integrity. This position reviews outcomes that are communicated to the team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in practices and to improve the quality of physician documentation within the body of the medical record to support code assignments and communicates outcomes to the CDS team to provide specific education, based on the quality monitoring review findings and trends. This position promotes a partnership between the concurrent clinical reviewers, medical record coders, and physicians to improve documentation and reimbursement.PEOPLE ESSENTIAL FUNCTIONS
Acts as documentation liaison with Health Information Management, Case Management, ancillary departments, physicians, staff, and management.
Assists in ensuring Clinical Documentation Specialists (CDS) adherence with clinical documentation and coding guidelines and policies.
SERVICE ESSENTIAL FUNCTIONS
Serves as subject matter expert and clinical resource for CDS and coding staff to clarify and interpret medical record documentation for complete and accurate coding and DRG assignment.
Interacts and communicates with physicians and other providers as needed, educating them in the process of clarifying documentation in the medical record.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
Ensures/Performs ongoing Quality Assurance reviews on each CDS based on Department Policies and Procedures and CDS Job Description, utilizing Training Manual, ICD-10-CM/PCS Coding Volumes, Coding Clinic, DRG Expert, AHIMA Compliant Query Guidelines and any other relevant sources and reports findings to leadership and staff.
Evaluates the monitoring tools and applies action plans specific to the outcomes to improve the program.
Supports the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes.
Evaluates the monitoring tools and applies action plans specific to the outcomes to improve the program.
Identifies special reviews or projects for review and clinical documentation improvement.
FINANCE ESSENTIAL FUNCTIONS
Promotes clarification of clinical documentation, advocating for appropriate reimbursement for the patient care resources consumed and the level of service rendered.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
Generates and communicates new ideas and suggestions that improve quality, service, or finance.
Maintains and applies up-to-date knowledge of official clinical documentation and coding guidelines, policies and procedures, and clinical/medical resources to assure knowledge and skills remain current.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.EDUCATION
Bachelor's degree from an accredited school of nursing OR Medical School graduate where Western Medicine is practiced
Master of Science in Nursing or other master's degree in a related field preferred
WORK EXPERIENCE
Three years of recent clinical documentation experience in an acute care hospital
Academic hospital experience and coding experience preferred
LICENSES AND CERTIFICATIONS - REQUIRED
RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure For RN within 60 days OR
RN-Temp - Registered Nurse - Temporary State Licensure For RN within 60 days AND
For Medical School graduate - Must have one of the following:
CCDS - Clinical Documentation Specialists (ASDIS) OR
CDIP - Certified Documentation Integrity Practitioner (AHIMA) OR
CCS - Certified Coding Specialist (AHIMA)
LICENSES AND CERTIFICATIONS - PREFERRED
CCS - Certified Coding Specialist (AHIMA)
KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Demonstrates knowledge of DRG payor issues, appropriate DRG assignment alternatives, clinical documentation requirements, and referral policies and procedures
Demonstrates accountability and professional development
Requires excellent observation skills, analytical thinking, problem solving, plus good verbal and written communication
Ability to interact and maintain regular significant contacts with other personnel throughout the institution (including but not limited to - physicians and their staff, mid-level providers, mid-level staff, coders, Case Managers); contacts methods may be in person, by telephone, or through correspondence
Ability to display assertiveness while being even tempered, with a pleasing personality and the ability to communicate easily with others
Working knowledge of Microsoft products including PowerPoint, Word, Excel and Outlook
SUPPLEMENTAL REQUIREMENTSWORK ATTIRE
Uniform No
Scrubs No
Business professional Yes
Other (department approved) Yes
ON-CALLNote that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call No
TRAVELTravel specifications may vary by department
May require travel within the Houston Metropolitan area No
May require travel outside Houston Metropolitan area No
Company Profile:Houston Methodist is one of the nation’s leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.Houston Methodist is an Equal Opportunity Employer.Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.