Clinical Documentation Integrity Lead – Service Line

🔥 37 minutes ago

🇺🇸 United States – Remote

💵 $72 - $96 / hour

⏰ Full Time

🟠 Senior

🏥📝 Medical Writer

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Stanford Health Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1991

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Stanford Health Care is a leading healthcare provider affiliated with Stanford University, offering a wide range of medical services, including primary, specialty, and emergency care. Known for its cutting-edge research and innovation in medicine, the facility also partners with Stanford Medicine and Stanford School of Medicine to provide top-tier medical education and research opportunities. Patient care is enhanced through their MyHealth online and mobile platforms, allowing easy access to medical records, appointment scheduling, and bill payments. Stanford Health Care is dedicated to improving health outcomes through advanced technology, personalized care, and comprehensive health services.

📋 Description

• Partner with service line and physician leadership to optimize documentation tools, improve processes, and reduce provider administrative burden • Manage and optimize relationships between CDI and assigned service lines • Meet regularly with service line physician champions and chairs/chiefs • Monitor and escalate queries to improve workflow efficiency and query turnaround • Perform targeted CDI audits and analyze findings related to documentation and coding • Build physician education and identify individual and service line opportunities • Serve as a subject matter expert on CDI practices, coding rules and regulations • Conduct compliance risk assessments and identify documentation opportunities • Monitor and evaluate CDI and coding quality against best practices • Complete project-related reviews and provide feedback to peers, coding, CDI leadership and quality partners • Coordinate data collection and analysis related to patient care, documentation, coding and clinical outcome gaps • Coordinate multidisciplinary working sessions for goal setting and problem solving • Optimize service line CDI programs and create, deliver and evaluate provider and multidisciplinary education • Lead multidisciplinary and multi-departmental CDI projects • Partner with CDI leads, IT and technology partners to create and optimize documentation tools, processes and strategies

🎯 Requirements

• Bachelor’s degree in Nursing, Medicine, Health Information Management or similarly related field of study • At least two currently active certifications from the listed certification categories • At least 5 years of progressively responsible and directly related inpatient clinical experience • At least 5 years of CDI, or provider education related work experience • Outcomes data reporting and analysis experience • Expertise in coding and CDI practices • Expertise in Medicare/Medicaid rules and regulations • Knowledge of CMS coding guidelines and methodologies, MS-DRGs, APR-DRGs, HCCs, CM/PCS and AMA CPT coding guidelines • Extensive knowledge and experience in computer systems, reporting software and electronic medical record systems • Demonstrated leadership ability, organizational savviness, and critical thinking skills • Strong collaborative, interpersonal, verbal and written communication skills • Knowledge of project management processes and systems • Knowledge of statistical analysis and reporting practices • Expertise in developing and delivering training and education • At least one currently active certification: CCDS or CCDS-O or CDIP • ICU/ED and Academic Medical Center experience preferred • Case management, utilization review and/or direct provider interaction experience preferred • Public speaking and formal multidisciplinary education experience preferred • Experience with Vizient, Premier, Elixhauser and other risk adjustment methodologies highly preferred

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