Outpatient CDI Analyst
Company: Yale New Haven Health
Location: New Haven
Posted on: February 22, 2021
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We're ready to chat! Can you provide us some info? Posted Date 1
month ago (3/10/2020 2:52 PM) Requisition ID 17150 Job Locations
US-CT-New Haven Category HIM/MED RECORDS Position Type Full Time
Benefits Eligible Department HIM Coding Scheduled Hours 40 Overview
To be part of our organization, every employee should understand
and share in the YNHHS Vision, support our Mission, and live our
Values. These values - integrity, patient-centered, respect,
accountability, and compassion - must guide what we do, as
individuals and professionals, every day.
The OP Clinical Documentation Improvement Specialist (OP-CDIS),
working under the direction of the OP Coding Supervisor, utilizes
compliant documentation improvement principles and coding expertise
to identify areas of opportunity that impacts the quality and the
completeness of the medical record documentation. Through current,
prospective, and retrospective evaluation of the medical record
documentation the OP-CDIS will be responsible for working
collaboratively with the clinical team members to clarify
documentation via clinically compliant physician queries, support
medical necessity, and provide education with the end goal of
achieving improved documentation results and reduction of
unnecessary denials for the organization. The overall outcome will
be documentation that accurately and completely captures the
clinical picture/severity of illness/patient complexity while
providing specific and complete information to be used in coding
and reporting of outcomes for the facility and the physicians. The
OP-CDIS utilizes knowledge of coding guidelines, coding/billing
compliant practices, payer policies, Hierarchical Condition
Categories (HCCs), policy manuals/coverage determinations, denial
data, and clinical knowledge to identify opportunities that are
compliant and appropriate to achieve maximum results. This
individual also supports other team members, shares knowledge and
role models the professional standards of behavior.
- 1.--Performs systematic chart reviews on a daily basis to
improve the overall quality and completeness of the clinical
documentation. Identifies the most appropriate CPT and ICD-10-CM
diagnoses codes that accurately reflect the services performed and
identifies when additional steps are needed in an effort to
potentially prevent unnecessary denials using a wide range of
references such as various clinical payer policies, LCD/NCDs,
- 2.--Compliantly queries physicians and clinicians to clarify
clinical documentation by applying coding and/or clinical knowledge
to accurately support medical necessity, procedure codes, and
accurate HCC capture assignment.
- 3.--Consistently maintains quality and productivity standards:
Meets daily review, query and query response targets.
- 4.--Understand risk adjusted payment methodologies, HCC
assignment and payment methodology, professional coding and
billing, outpatient facility coding and billing, APC assignment,
and OPPS reimbursement methodology and shares this knowledge with
colleagues and clinical team members.
- 5.--Educates medical staff on documentation requirements,
documentation improvement areas, and coding guidelines to
accurately reflect the complexity and shows the medical necessity
of the visit
- 6.--Resolves all OP-CDIS assigned work and provides feedback
and education to claim analysts and OP Coding Supervisor.
- 7.--Participates, as needed, in providing 1:1 and/or group
education to clinical team members and/or colleagues in
coding/claim edits/denials and/or clinical documentation
- 8.--Recognizes or works collaboratively with others to identify
the key issues resulting in provider liable accounts and makes
recommendation to improve the entire process in order to
effectively reduce the number of these accounts. Looks for ways to
continually to improve the process that will result in a lower
incidence of provider liable accounts. Is actively involved in
appeals and/or denials as needed to support this work efforts.
- 9.--Develops and delivers education to the medical staff,
clinicians, and department team members team members in the
application of coding guidelines and practices, proper
documentation techniques, etc. using a variety of teaching methods
including, but not limited to: small group presentations,
department meetings, physician in-services in person and remotely
through the use of technology.
- 10.--Shadows Inpatient CDI team members to identify
commonalities and areas of opportunity in the work performed.
- 11.--Leads efforts to evaluate HCC and procedure documentation
and provides recommendations to improve documentation and
- 12.--Collaborates with clinical staff, ITS, and others on
identifying software and template improvement opportunities
- 13.--Leads and/or actively participates in meetings. Actively
participates in department performance improvement and employee
- 14.--Performs all other duties or special projects requested by
Coding leadership and proactively communicates any problems that
arise to maintain a smooth operation of the department.
- 15.--Exhibits enthusiasm for the profession, embraces
educational opportunities and department support offered and
remains engaged in the goals and vision of the department. Role
models the professional standards of behavior and encourages staff
to do the same. Qualifications EDUCATION Two (2) years of college
or equivalent. Working knowledge of human anatomy/physiology and
disease processes through coding knowledge or education is needed.
Health Information Management or Nursing education a plus.
EXPERIENCE Five (5) years of outpatient facility coding in multiple
coding service lines or billing related claim edit experience, or
strong medical background with 3-5 years' acute clinical
experience. Thorough knowledge of clinical documentation
requirements, coding, guidelines, and regulatory requirements
related to coding and coding compliance. Ability to communicate
effectively with physicians verbally and in writing.
Epic HB billing knowledge preferred. LICENSURE Certified coder
through AHIMA or AAPC (CCS, CCS-P, CPC, or COC) or LPN/RN with
clinical experience and required to obtain coding certification
within 6 months from hire. CDOE certification after 2 years of
experience. CRC certification a plus. SPECIAL SKILLS Very strong
communication skills, written and oral, for communication with
Medical Staff and other healthcare professionals are a must.
Ability to perform well in a fast-paced team environment and to
manage time effectively. In-depth knowledge of medical terminology,
anatomy, physiology, and disease process. Comprehensive
understanding of ICD-10-CM classification systems. Expertise in
governmental payment policies and regulations including medical
necessity, NCCI, OCE, and MUE policies and procedures. Must be able
to train, educate, present and share knowledge and information.
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Keywords: Yale New Haven Health, New Haven , Outpatient CDI Analyst, Professions , New Haven, Connecticut
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