Clinical Documentation Integrity Coding Quality Liasion

Position Overview :

Under the direction of CDI leadership, the CDI Coding Quality Liaison oversees accuracy and completeness of the final coded set of diagnoses and procedures. After CDS chart review and potential and clinically appropriate query processes are completed, the Liaison becomes a gatekeeper for any Second Level Review (SLR) requests. Using both ICD-10 CM and PCS official coding guidelines, as well as CDI-related clinical expertise, the Liaison identifies opportunities and intervention points to correct incomplete codes required to capture the quality of care and resource consumption. The CDI Coding Quality Liaison monitors both CDS and Coder-initiated SLR request topics for education development and dashboard metric contributions. Additionally, the CDI Coding Quality Liaison Serves as a Diagnosis Related Group (DRG) expert, supporting clinical documentation initiatives across their assigned market areas.

Job Description :

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES :

• Monitors all SLR-related communications across their defined markets, facilitating appropriate SLR requests bi-directionally between CDI and Coding, preventing SLR request redundancy and ensuring a streamlined process for efficient final DRG assignment
• In conjunction with the CDI Educator / Quality Auditor, utilizes commonly encountered SLR request subject matter, along with Coding Clinic updates and the latest CDI practice standards, to develop education content for both CDS and coding team members.
• Share QA Audit findings with CDI Leadership and Educates CDI Staff on missed SLR coding opportunities. Works in collaboration with CDI Educator and Coding Quality Team to design and present education materials for delivery support the CDI and Coding team.
• In conjunction with the CDI manager, evaluates education needs for coders and CDI specialists based upon Second Level Review (SLR) request subject matter and outcomes
• Meets routinely with Coding Department counterparts to discuss non-compliance with SLRs. Meets regularly with CDI Leads to discuss compliance issues.
• Develops and submits monthly CDI physician champions reports related to and KPIs with a focus on case studies illustrating missed documentation opportunities.
• Represents the CDI Department alongside CDI leadership in routine meetings with Coding Department leaders, serving as a subject matter expert for trended discrepancies requiring process changes beyond education initiatives
• Liaison will monitor and distribute the request on the SLR / Sepsis work queue
• Serves as a real-time coding resource for CDI Leads, CDSs, and resolves questions related to coding grey areas subject to multiple interpretations and code assignments
• Works with the EPIC Technical Consultant to update provider note templates, dot phrases, documentation drop-down menus, and CDS query templates based on coding changes, regulatory modifications and quality review findings.
• Support CDI related processes that ensure complete and accurate Physician documentation practices that will back denial management processes including but not limited to denial prevention
• In addition to the key accountabilities listed, employees working in this position are expected to accept and perform other duties as requested.

EDUCATION : Bachelors degree

TYPICAL EXPERIENCE :

3 years IP Coding experience.

CERTIFICATION & LICENSURE :

Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP)

Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)

SKILLS AND KNOWLEDGE :

Knowledge of Pathophysiology and Disease Processes sufficient to pass the clinical pre-employment test at a rate of 85% or better is required for new hires.

Subject matter expertise in the area of clinical documentation to ensure the completeness of the patient records using multidisciplinary and interdisciplinary teams.

High degree of hospital coding knowledge, including but not limited to APR-DRG, MS-DRG, HCCs, Medicare, Medicaid & Managed Care, in order to design and develop strategies to yield improvements to documentation that will improve overall patient quality, capture severity, assess acuity and determine risk of mortality.

Thorough knowledge of clinical documentation requirements, clinical procedures, disease processes, treatments, and the patient populations served.

Subject matter expertise regarding quality and reimbursement implications of clinical documentation and coding.

Up-to-date knowledge of ICD-10 mandate and the impact of code set transition, including potential impact on data quality for prospective payments, utilization, and reimbursement.

Demonstrated familiarity and adept use with software and technical applications including but not limited to : Microsoft Office products (Outlook, Excel, Word, PowerPoint), Electronic Health Records, Encoder, Healthcare databases.

Strong Organization and Quantitative Analysis skills including spreadsheet applications and statistics.

Pay Range : $63.74-$95.60 / hour

Job Shift : Days

Schedule : Full Time

Shift Hours : Days of the Week :

Variable

Weekend Requirements :

None

Benefits : Yes

Unions : No

This position is work from home eligible.

Position Status : Non-Exempt

Weekly Hours : 40

Employee Status : Regular

Number of Openings :

Sutter Health is an equal opportunity employer EOE / M / F / Disability / Veterans.

Pay Range is $65.81 to $98.71 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.