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Clinical Documentation Improvement CDI Auditor RN

El Paso, TX, United States

This job posting is no longer active.

Description

SHIFT: Days (rotating weekends)

SCHEDULE: Full-time

Las Palmas Del Sol Healthcare is the leading healthcare provider for El Paso and the surrounding region. Our physicians, nurses and staff are committed to keeping our community healthy and delivering the highest quality patient care available.

 Las Palmas Del Sol Healthcare provides full-service acute care hospitals offering comprehensive medical services in nearly every specialty, so you are never far from the care you need.
 

As a part of HCA, the largest hospital chain in the world, Las Palmas Del Sol Healthcare brings unsurpassed healthcare resources to El Paso, Texas. Our medical teams include some of the finest physicians in the nation, and we continue to recruit physicians to the area to meet the needs of our expanding population.


BENEFITS:

We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program. We would love to talk to you about this fantastic opportunity.

  

POSITION SUMMARY

Provides clinically based concurrent and retrospective review of inpatient medical records.  The goal of concurrent review includes facilitation of appropriate physician documentation of the diagnoses and procedures for each patient in order to reflect the level of resource consumption, patient severity of illness and risk of mortality. The Clinical Documentation Improvement Auditor (CDI) is also responsible for providing education to the physicians and, as applicable, other disciplines, in order to secure the most complete and accurate documentation possible.  The CDI Auditor also works with various departments such as Quality, Case Management, and other ancillary departments on common initiatives.  In addition, the CDI Auditor is responsible for reconciling the concurrent review working DRGs with the final coded DRGs from the Shared Service Center.   These reviews are critical to assuring accurate reimbursement to the facility. 


BENEFITS:

We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program. We would love to talk to you about this fantastic opportunity.

 

 

ESSENTIAL FUNCTIONS

  • Performs concurrent review of the clinical documentation in the medical record.
    • Queries the physician and other caregivers as allowed, to clarify documentation
    • Performs follow up reviews and follows the patient through discharge
  • Performs job duties within the standards for productivity
  • Performs the job duties within the standards for quality
  • Utilizes the CDI system efficiently to achieve desired outcomes
    • Demonstrates proficiency for data entry in the system
    • Demonstrates proficiency in using other adjunct systems, eg Excel
    • Demonstrates proficiency in utilizing various reports
  • Serves as a resource to the medical staff, administration and ancillary services
    • Makes presentations to educate the medical staff and ancillary departments as needed. 
    • Ensures the information is clear, concise and accurate.
    • Speaks articulately
  • Performs retrospective reviews on final coded records
    • Reconciles the working DRG with the Final DRG
    • Documents reasons for any discrepancies
    • Submits the appropriate documentation as needed when there is disagreement between the CDI Working DRG and the Coder’s Final DRG
    • Follows up on accounts submitted to ensure rebill deadlines are not missed
    • Follow appropriate escalation procedures as needed
    • Performs retrospective reviews within the established time frames required by the CDI Department.
  • Demonstrates knowledge of the CMS Inpatient Prospective Payment System DRG assignment and the APR/DRG classification systems
    • Proficiently uses the system to determine codes, complications and comorbidities
    • Understands the importance of Coding guidelines in order to determine the principal diagnosis, principal procedure, secondary diagnoses and procedures, as well as the various impact certain codes have on quality outcomes data
  • Demonstrates thorough understanding of HCA’s query handbook
    • Escalates complicated queries for a second opinion as necessary
    • Notifies the appropriate manager when inappropriate or noncompliant queries are identified
    • Is proficient in performing query audits as needed. 
  • Demonstrates a positive attitude and makes reasonable suggestions for improvement
  • Employee’s conduct must reflect the Company’s values and a commitment to the Code of Conduct ethics and compliance program.
  • Employee reflects LPDS Service Excellence standards in every interaction.

Qualifications

REQUIRED EDUCATION/EXPERIENCE

Required:Graduate of or completion of required coursework from an accredited school of nursing resulting eligibility for NCLEX examination.   Two years’ experience in an acute care setting outside of OB and pediatric services.  

 
REQUIRED LICENSURE/CERTIFICATIONS

Required:Texas RN License or a Compact RN license from a NCLA Compact State. 

 

PREFERRED EDUCATION, LICENSURE, CERTIFICATION, EXPERIENCE, SKILLS, KNOWLEDGE AND ABILITIES

 

Preferred: BLS certification as per LPDS policy; ACLS certification as per LPDS policy. 

 

SKILLS, KNOWLEDGE, AND ABILITIES

Required:   Knowledge of care delivery documentation systems and related medical record documents. Knowledge of age-specific needs and the elements of disease processes and related procedures. Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes. Excellent critical thinking skills. Demonstrated good nurse-physician relationships in the past and has the ability to maintain those going forward. Working knowledge of inpatient admission criteria. Ability to work independently in a time-oriented environment.  Must demonstrate typing proficiency.  Must be proficient with the operation of basic office equipment. Assertive personality traits to facilitate ongoing physician communication. Ability to stand and walk for periods of time is required in the performance of job responsibilities. Working knowledge of Medicare reimbursement system and coding structures preferred, but not required. Ability to clearly speak, write and understand verbal and written English. Selected skills/credentials as defined by the department's scope of services. Comfortable with public speaking.  Must be able to communicate effectively both verbally and in writing.

 

Must be able to demonstrate understanding of national patient safety initiatives by strict compliance to all safety protocols and procedures as required by both HCA.


Las Palmas Del Sol Healthcare
Facility: Las Palmas Del Sol Healthcare
Job ID: 01615-19615
Category: Case Management
Contract: Full-time
Shift: Days (rotating weekends)
Job Class: Regular

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