Director HR Operations & Education



Eastern Maine Medical Center

Position Description

Director, Associate Director, or Manager

Job Title: CDI Manager

Department: HeIS - Coding

Date Issued/Revised: 12/31/15

FLSA Exempt

1. GENERAL POSITION SUMMARY: Responsible for planning and managing the human, material, equipment and fiscal resources for areas of responsibility and accountable for developing action plans to contribute to the organization’s ability to carry out its mission and accomplish annual pillar goals.

2. SPECIFIC POSITION SUMMARY: Provides direction and leadership for

|clinical documentation improvement efforts through a formal CDIP (Clinical Documentation Improvement Program). Demonstrated skills in |

|work process management, quality improvement monitoring and work team leadership. Responsible for directing the CDI operations for |

|Eastern Maine Medical Center to ensure standardization, improved physician quality documentation, appropriate reimbursement, and |

|ongoing monitoring of CDI metrics and staff. |

3. GENERAL MAJOR DUTIES AND RESPONSIBILITIES:

Essential functions are identified by an asterisk.

A. Responsible for safety*

1. Insures that the department environment is free from recognized hazards that create a risk of injury to healthcare workers, patients and/or visitors.*

2. Supports and facilitate open and non-punitive communication between healthcare workers, patients and families regarding clinical and environmental safety on their unit and when interfacing with other units, groups and individuals.*

3. Supports and facilitate employee and non-employee healthcare workers in reporting and directly and addressing patient and environmental safety concerns.*

4. Accountable for accident/injury prevention and investigation including root cause analysis, as well as assisting in the return of injured workers to gainful employment.*

B. Maintains excellence in customer services through measurement and improvement action plans.*

C. Ensures the efficient and effective operations of processes in the delivery of service/care for areas of responsibility.*

D. Accountable for budgeting and financial performance.*

E. Monitors compliance with legal and accrediting requirements related to areas of responsibility

functions and services.*

F. Engages staff in providing and improving service delivery.*

G. Recognizes staff and others for contributions.*

H. Commits to assist in EMMC achieving its Equal Employment Opportunity and Affirmative Action goals.*

I. Conducts ongoing high, middle, and low performer conversations with direct reports including appropriate follow up. Holds direct reports accountable for same with subordinate leaders and staff.*

J. Creates a self-development plan to improve leader skills, competence, and outcomes.*

4. SPECIFIC MAJOR DUTIES AND RESPONSIBILITIES:

Essential functions are identified by an asterisk.

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|PEOPLE |

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|*Determines work procedures, prepares work schedules, builds/maintains work lists (3M), and expedites workflows within the HEIS CDI |

|Section for all inpatient and outpatient coding documentation improvement requirements at Eastern Maine Medical Center. |

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|Maintain excellent communication and relations with coding, physician, and compliance staff. |

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|Exhibit EMMC Caring Behaviors and support senior leadership in achieving short and long term organizational goals. |

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|*Hold bi-weekly CDI meetings for staff. |

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|*Demonstrates effective and courteous customer, physician/staff, and other hospital staff communication skills. Answers calls promptly|

|and courteously. Responds to and resolves issues promptly through effective communications. |

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|SERVICE |

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|Schedules training and orientation sessions for both new and existing employees (e.g., Cerner, Outlook, 3M 360, etc.). |

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|*Reviews, evaluates and updates job descriptions annually or as needed. |

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|*Develops, coordinates and oversees implementation and standardization of CDI policies and procedures that support revenue cycle, |

|organizational goals, timely, complete and accurate coding business objectives. |

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|*Active participation with Director on CDI Steering Committee, Physician service meetings. |

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|*Oversee payroll submission; verifying accuracy, completeness, and compliance with EMMC attendance policy. |

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|*Ensure timely submission of employee performance appraisals with discussion of strengths and opportunities for improvement. |

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|*Lead recruiting efforts to hire and retain highly competent staff, oversee CDI orientation program content, facilitate training and |

|performance development, and enforce CDI policies and procedures. |

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|Leverage technology to improve the quality and timeliness of CDI staff. Be forward thinking with regard to the use of technology and |

|its application to the documentation improvement process. Utilize existing technologies to the fullest to ensure revenue optimization |

|and coding efficiency. |

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|Complete special projects as assigned by Eastern Maine Medical Center, which require defining problems, determining work sequences, |

|summarizing findings, and implementing solutions. |

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|*Build, maintain, and distribute listing and summary reports utilizing the 3M HDM & 360 databases at the request of various clinical |

|and non-clinical departments. |

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|*Monitor prebill audit processes for physician queries, working DRGs/ |

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|*Perform disciplinary action as needed following EMMC personnel policies. |

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|QUALITY . |

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|*Assist Staff in review of 3rd party denials and/or RAC by advising in conjunction with the Director on the following: |

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|• Review content of documentation related to MS-DRG denials and determine if applicable documentation or clarification is needed (e.g.,|

|queries, updates, missing documentation) |

|• Include documentation and written response from experts involved in the case to provide clarification or insight into MS-DRG |

|assignment |

|• Review regulatory guidance (e.g., Coding Clinic, ICD-9-CM Official Guidelines for Coding and Reporting, local and national coverage |

|determinations, fiscal intermediary/CMS billing guidance) with regard to the date of the account in question. |

|• Determine whether there were any changes in regulatory guidance that would support or deny an appeal on the case in question. If |

|there is, note the guidance changes and decide if next steps are needed from an appeal standpoint. |

|• Submit and monitor timely filing of open discussion period, and Appeal levels. |

|• Produce monthly summary reports detailing # of requests received, # of underpayments and amount, # of overpayments and amount, # of |

|accounts pending, # of medical necessity denials and amount, # of accounts successfully overturned, # of accounts approved, and the net|

|impact to EMMC. |

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|*Implements internal QI schedule for CDI staff |

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|Demonstrates mastery of clinical systems for documentation within organization. |

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|*Ensures that all targets and departmental goals are met on an ongoing basis, monitoring Quality and Productivity standards |

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|*Direct CDI quality and productivity by implementing consistent quality and productivity standards by utilizing appropriate monitoring |

|tools. |

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|*Present analysis, findings and recommendations to Director of coding & CDI and QA leadership. Escalate significant indicators of poor |

|performance and facilitate action plans. |

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|*Revise procedures and policy in response to indicators of poor quality to ensure compliance with correct coding guidelines, third |

|party payer and governmental requirements. |

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|Maintain competency in coding and compliance including CPT, ICD-10, MS-DRG, compliance and third party payer guidelines. |

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|*Monitor HAC (hospital acquired condition) and POA (present on admission) reporting for as it relates to coding accuracy and |

|documentation improvement. |

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|*Responsible for ongoing clinical documentation improvement for EMMC through concurrent nurse reviews (CDS) and physician education. |

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|• Recruit, train and manage RNs who specialize in clinical documentation review for impact on MS-DRG assignment, complication & |

|comorbidity capture, hospital acquired condition reporting, and present on admission indicator assignment for final billing/reporting. |

|• Develop educational presentations for physicians and allied health professionals on clinical documentation improvement for EMMC. |

|• Conduct physician and allied health professional education on a PRN basis, or at least annually on CDIP. |

|• Run monthly data dump reports for use in analyzing success of the CDIP program. |

|• Utilize monitor reports to identify low weighted DRGs with high volume, and high weighted DRGs with low volume. Focus documentation |

|reviews and work with physicians to appropriately document for accurate MS-DRG assignment. |

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|FINANCE |

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|*Provide Director with input into salary and expense budget for HeIS coding & CDI. |

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|*Monitor accounts receivable reports and maintain organization goal. Provide reports detailing status of accounts pending billing for |

|both inpatient and outpatient services. |

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|*Analyze monthly monitor reports for financial impact of CDIP and adjust prebill DRGs accordingly. |

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|*Monitor physician query response rates by service line and provide administration with monthly compliance rates. |

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|GROWTH |

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|*Seek and support personal growth through continuing education focused on CDI, coding and leadership skills. |

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|*Provides educational opportunities for employee growth and retention thru continued education offerings. |

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|Administer annual CDI competencies focused on ICD-10-CM and DRG code assignment. |

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|*Attend all leadership workouts and employee updates (as appropriate), and participate in leadership skills development opportunities. |

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|COMMUNITY |

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|*Accommodate requests for subject matter experts in CDI compliance efforts, management of CDI services, and utilization of CDI & Coding|

|systems. |

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|Conduct presentations upon request for ACDIS Local Chpater, MeHIMA (Maine Health Information Management Association), AAPC (American |

|Academy of Professional Coders), AHIMA (American Health Information Management Association), and HIM programs both within and outside |

|the state. |

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|*Maintain membership with ACDIS (Association for Clinical Documentation Improvement Specialists) in efforts to stay current on coding |

|and clinical documentation improvement. |

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5. TECHNICAL REQUIREMENTS:

An expert knowledge of ICD-10 coding for inpatient services is required. Expertise in MS-DRG reimbursement methodologies, HAC reporting, and POA assignment is needed. Expertise in managing Recovery Audit Contractors (RAC) activity as it relates to outpatient charging/coding, and inpatient DRG assignment is a plus. Ability to analyze Case Mix Index (CMI) and severity/mortality data for the facility through knowledge of clinical documentation improvement methodologies. Advanced knowledge of medical terminology, anatomy and physiology, diagnostic tests, medications and medical/surgical procedures and services is required. Must have demonstrated abilities in the area of work redesign and process improvement. Previous supervisory experience is needed. Proficiency with computers and use of spreadsheets and encoders required. This position requires demonstrated leadership qualities. Must act with minimal supervision, notice or direction to identify and resolve problems and complete work. Must be able to communicate through formal presentations the business case or operational analysis, status, recommended actions and impacts to senior management on an ongoing basis.

6. SPECIAL SKILLS:

Trained on ICD-10-CM/PCS and clinical documentation improvement efforts

7. EXPERIENCE/EDUCATION REQUIRED/PREFERRED:

Bachelor's required with a minimum of five years experience with ICD-10-CM, and MS-DRG assignment. 3-5 years of leadership experience required.

8. LICENSES OR CERTIFICATIONS:

RN with CCDS, RHIA, or RHIT required. ICD-10-CM/PCS Training required.

9. PHYSICAL ENVIRONMENT (If the demands of the position are any other than a typical

office/clinical setting):

     

10. PHYSICAL DEMANDS:

Light to medium carrying up to 50 lbs., straight pulling/pushing, reaching in all directions, stooping, walking long distances, standing, sitting, repetitive motion/finger activity for sustained periods of time, speaking, hearing, moderate phone contact, visual activity; long periods of working on computer.

     

11. SUPERVISES:

Titles of direct report leaders, number of staff

Direct Reports: 7 CDI nurses, 1 CDI Lead, 4 Health Information Coders dedicated to ED, 1 Anesthesia Coder & 1 Coordinator, 1 Health Information Coder dedicated to EMIC

12. REPORTS TO: Director of Coding and Clinical Documentation Improvement

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