Quality CDI Analyst, RN

The Quality CDI Analyst is responsible for performing quality reviews on medical records to validate ICD-10 CM/PCS codes, DRG appropriateness, missed secondary diagnoses and procedures or interventions, to accurately reflect all conditions present during the admission period, quality of care, severity of illness, and risk of mortality to support quality initiatives, correct coding, and reimbursement. Requires a strong understanding pathophysiology and disease processes, healthcare decision-making and treatment workflow, coding classifications, and communication. Other responsibilities include sending compliant physician queries, as recommended by ACDIS and AHIMA, and working closely with the physician advisor, coding, CDI, HIM, and Quality leadership teams regarding opportunities for documentation improvement. SPECIFIC SKILLS NEEDED

• Clinical experience with an acute care inpatient background, preferably in Critical Care or the Emergency Department
• Ability to write queries that are compliant with the ACDIS and AHIMA guidelines, and are concise and easily understood by the provider to obtain additional information and clarification of documentation
• Extensive knowledge of pharmacology and pathophysiology and disease processes
• Strength in attention to detail—highly organized
• Ability to work independently with a high degree of self-motivation
• Critical thinking, creative problem solving, and conflict management skills
• Persistent demonstration of accountability, accuracy, thoroughness, and sound judgment
• Excellent communication skills, both verbal and written
• Ability to anticipate needs and place audience at the center of own thinking and actions
• Ability to establish and maintain effective working relationships with all departments
• Strength in risk identification and appropriate escalation
• Able to deal with frequent change or unexpected events
• Experience with criteria-based chart review, such as Case Management, Utilization management, Managed Care, and preferable in Quality Improvement
• Strength in ICD-10 and MS-DRG structures, HACs, PSIs, value based purchasing, bundled payments, accountable care organizations and readmission reduction programs
• Ability to interpret specifications for the IQR Programs
• Ability to reference and interpret CMS guidelines and regulatory requirements