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CDQI Auditor in Alpharetta, GA at CIOX Health

Date Posted: 11/1/2018

Job Snapshot

Job Description

The Clinical Documentation Quality Improvement (CDQI) Auditor performs daily evaluations of medical record documentation to include provider notes, lab results, diagnostic information and treatment plans, and communicates with providers face-to-face or via query forms to clarify or obtain the missing, unclear or conflicting documentation. The clarified physician documentation within the medical record results in the support of the overall quality and completeness of the medical record documentation for code assignment.



Responsibilities

  • Demonstrates an understanding of complications, co-morbidities, severity of illness, risk of mortality, case mix index, secondary diagnoses, and the impact of procedures on the final Diagnosis Related Group (DRG).
  • Performs timely, accurate and complete documentation reviews of selected inpatient records to clarify conditions/diagnoses and procedures in which inadequate or conflicting documentation exists.
  • Collaborates with physicians and other patient caregivers to support that appropriate reimbursement and clinical severity is captured for the level of service rendered to all patients with a DRG based payer.
  • Improves coding specificity by educating physicians, clinicians, and other involved parties regarding the necessity of providing complete and clear documentation of the care provided throughout a patient's stay.
  • Follows AHA guidelines and coding clinics for coding and required documentation to ensure physician and hospital compliance. Remains current with coding information to ensure accuracy of codes assigned based on documentation.
  • Queries physicians or physician extenders regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the health record when needed.
  • Keeps daily production logs containing number of cases reviewed, number of queries placed/responded, etc. for weekly evaluation of output.
  • Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded within the patient's medical record.
  • Maintains and keeps in total confidence, all files, documents and records.
  • Meets or exceeds production and quality metrics.
  • Performs all other job-related duties as it relates to job function as delegated by management.


Qualifications

  • Minimum Education: Bachelor's Degree, HIM certification (RHIA, RHIT, CCS)
  • One to Three years experience as a CDI Specialist,
  • Three years of recent experience as an inpatient coder, certificate from accredited coding school, demonstrated knowledge and clinical experience relevant to clinical and regulatory aspects of care and reimbursement

Preferred Qualifications:

  • Working knowledge of federal, state, and payor specific regulations and policies pertaining to documentation, coding and reimbursement, excellent written and oral communication skills, demonstrated ability to multi task and apply critical thinking skills.