Quality CDI Analyst, RN

The Quality CDI Analyst is responsible for performing quality reviews on medical records to validate ICD-10 CM/PCS codes, DRG appropriateness, missed secondary diagnoses and procedures or interventions, to accurately reflect all conditions present during the admission period, quality of care, severity of illness, and risk of mortality to support quality initiatives, correct coding, and reimbursement. Requires a strong understanding pathophysiology and disease processes, healthcare decision-making and treatment workflow, coding classifications, and communication. Other responsibilities include sending compliant physician queries, as recommended by ACDIS and AHIMA, and working closely with the physician advisor, coding, CDI, HIM, and Quality leadership teams regarding opportunities for documentation improvement. SPECIFIC SKILLS NEEDED • Clinical experience with an acute care inpatient background, preferably in Critical Care or the Emergency Department • Ability to write queries that are compliant with the ACDIS and AHIMA guidelines, and are concise and easily understood by the provider to obtain additional information and clarification of documentation • Extensive knowledge of pharmacology and pathophysiology and disease processes • Strength in attention to detail—highly organized • Ability to work independently with a high degree of self-motivation • Critical thinking, creative problem solving, and conflict management skills • Persistent demonstration of accountability, accuracy, thoroughness, and sound judgment • Excellent communication skills, both verbal and written • Ability to anticipate needs and place audience at the center of own thinking and actions • Ability to establish and maintain effective working relationships with all departments • Strength in risk identification and appropriate escalation • Able to deal with frequent change or unexpected events • Experience with criteria-based chart review, such as Case Management, Utilization management, Managed Care, and preferable in Quality Improvement • Strength in ICD-10 and MS-DRG structures, HACs, PSIs, value based purchasing, bundled payments, accountable care organizations and readmission reduction programs • Ability to interpret specifications for the IQR Programs • Ability to reference and interpret CMS guidelines and regulatory requirements • Strength in data collection, formatting, and management • Strength in the Microsoft suite of software and computer savviness EDUCATION/EXPERIENCE/TRAINING Required: • CCS, CCDS, or CDIP required by the end of employee probation period (typically 90 days), with onsite acute hospital-based clinical experience • Bachelor’s Degree in Nursing from a recognized college or university • Must have and maintain an active RN license in state of residence • Two years direct patient care experience in an acute hospital • Two years criteria-based chart review experience (i.e., Case Management, Utilization management, Managed Care, Quality Improvement) • Evidence of continuing education and self-development Preferred: • Clinical experience in Critical Care or the Emergency Department • Comprehension of various hospital business lines • Experience working with coding classifications (i.e. ICD-10 CM and PCS, CPT, and HCPCS) • Experience in use of the AHA Coding Clinic • Experience in data management, data analysis, Clinical Informatics, and/or statistical analysis • Experience with the Vizient Clinical Database (CDB), or equivalent application

Requires bachelor's degree in nursing, active RN license, CCS, CCDS, or CDIP by probation completion, 2 years acute hospital care, and 2 years criteria-based chart review experience.

Key Responsibilities

• reviewing medical records
• validating codes
• writing physician queries

Skills & Tools

ICD-10 CM/PCS, MS-DRG, Microsoft Office, CPT, HCPCS, AHA Coding Clinic, Vizient Clinical Database (CDB)

Job Details

• Category: Healthcare Services - Nursing
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — Dallas, Texas, United States
• Languages: English

About TEXASCONNECT INC

A management services organization providing business and administrative support to healthcare providers. — Industry: Healthcare

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