Job Summary
A clinical concurrent reviewer applies clinical and coding knowledge to concurrently evaluate the clinical indicators, diagnoses, and treatment plan for assigned inpatients and identifies potential gaps in physician documentation and CDI capture. The CDI second level reviewer (CDI SLR) is an advanced concurrent reviewer who uses his/her extensive Clinical Documentation Integrity (CDI) experience to perform a variety of second level reviews. The CDI SLR will conduct reviews post-discharge prior to final billing of target case populations, place queries if documentation opportunities are identified (for a case reviewed by a CDI, the query and details will be provided to the CDI for their delivery and follow-up) and collaborate with coding-on-coding opportunities. The CDI SLR will also respond to concurrent review requests from Clinical Documentation Integrity Specialists, escalate unanswered queries following the escalation process, and seek to improve process flow and SLR criteria when appropriate. Drawing on his/her advanced CDI knowledge, the CDI SLR will regularly analyze information and data to identify trends, areas of opportunity, provide feedback to the frontline Clinical Documentation Integrity Specialists, the managers, and work with the educator to establish educational subject matter.
Job Duties
- Performs post-discharge, final coded, pre-bill reviews of targeted records identified for second-level review for opportunity to accurately capture patient acuity, severity of illness, risk of mortality, quality measure and metric support, and DRG assignment in compliance with industry rules and regulations.
- If a documentation opportunity is identified, place physician query and follow up for response to ensure completeness and accuracy of the medical record.
- If coding opportunity is identified, coordinate with coder and/or Coding Manager to review and address opportunity, as applicable.
- Monitors and provides feedback to the CDI team to ensure clinically credible, effective, and compliant query practices.
- Reviews opportunity trends with CDIS educator to develop training/education.
- Responds to CDS requests for concurrent chart reviews.
- Maintains a summary of opportunities identified through second-level review for feedback and education with the CDS team on the tracking form/spreadsheet.
- Coordinate with other Second Level Reviewers and CDI Managers to compile trends and areas of opportunity and conduct education with the CDS team based on the findings.
- Develops and promotes collaborative processes and strong working relationships with physicians and other health care professionals to accomplish program goals and ensure exceptional documentation.
- Assist with periodic review of the criteria established for cases triggering a second-level review and recommend updates or modifications to the criteria to support identification of areas of opportunity.
Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.
Position Details
Experience with Epic and 3M-360 software.
One of the following certifications required:
- Certified Coding Specialist (AHIMA)
- Certified Clinical Documentation Specialist
Education
Graduate from Specialty Training Program-Nursing (Required), Bachelor’s Degree-Nursing (Preferred)
Experience
Minimum of 5 years-Related work experience (Required)
Certification(s) and License(s)
Certified Coding Specialist – American Health Information Management Association (AHIMA); Certified Clinical Documentation Specialist – Default Issuing Body
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.