Lead Clinical Documentation & Coding Consultant

JOB SUMMARY:
Provides leadership in developing and maintaining an ongoing education and training plans related to clinical documentation and inpatient/outpatient coding improvement. Develops and delivers educational programs and presentations. Serves as a resource for clinical documentation specialists (CDS) with areas of focus including query creation and compliance, coding requirements and updates. Facilitates strategies for monitoring third-party payor audits and ensures accurate and optimum payor reimbursement.


KEY RESPONSIBILITIES:

• Develops, secures approval, and updates the education and training plans based on internal necessity, new requirements, and published regulations. Ensures all training materials are recorded, documented, and archived.
• Coordinates, oversees, and collaborates with Clinical Documentation and Coding Excellence leadership (CDACE) to develop and implement improvements to processes.
• Regularly participates in the development of education and training on documentation for accurate coding practices and compliance issues.
• Prepares and delivers clinical documentation standards and best practices training for new providers.
• Implements timely corrective action to prevent payor payment denials.
• Analyzes data from multiple data sources to help identify areas of educational opportunity CDS and coding staff
• Identifies trends in clinical documentation and code assignments, evaluates the causes and takes appropriate steps to effect favorable problem resolution or provide explanation of any variables.
• Coordinates, oversees, and collaborates with medical center departments to develop and implement improvements to processes.
• Provides high level strategic oversight for Clinical Documentation Excellence and coding quality projects across the medical center.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

CLINICAL DOCUMENTATION IMPROVEMENT (EXPERT): - The ability to analyze and interpret medical record documentation and formulate appropriate physician queries; and an ability to benchmark and analyze clinical documentation program performance.

MEDICAL CODING (EXPERT): - The transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes.

MEDICAL TERMINOLOGY & DOCUMENTATION (EXPERT): - The ability to comprehend medical terminology and documentation in an office, or surgical setting.

ANATOMY & PHYSIOLOGY KNOWLEDGE (EXPERT): - Possesses sufficient anatomy and physiology knowledge, training, and experience. Ability to apply knowledge to real world situations.

CRITICAL THINKING (ADVANCED): - The objective analysis and evaluation of an issue in order to form a judgment.

COMPLIANCE (ADVANCED): - Understanding the rules, regulations, sanctions and other statutory requirements, guidelines and instructions relating to governing bodies and organizations, both internally and externally.

VERBAL COMMUNICATION (ADVANCED): - Ability to enunciate clearly, using appropriate voice control and body language. Effectively transmits technical and business ideas and information to others. Listens carefully to ascertain points being made before trying to be understood.

WRITTEN COMMUNICATION (ADVANCED): - Demonstrates the ability to write clear, detailed, and comprehensive status reports, memos, and documentation. Demonstrates an understanding of effective composition, such as having first line in a paragraph state the subject.

TEAM EDUCATION (ADVANCED): - Possesses sufficient knowledge, training, and experience to independently deliver healthcare team education services. Promotes critical thinking and problem solving. Able to train and educate by example, technical instruction, and leadership.

CORE ACCOUNTABILITIES:

• Organizational Impact: Delivers projects/assignments that have a direct impact on goals/objectives of the unit/department that the job is in.
• Problem Solving/ Complexity of work: Conducts extensive analysis of situations or data to resolve numerous, complex issues; may involve the input/work of others.
• Breadth of Knowledge: Has in-depth level of knowledge within a professional area and working knowledge of other areas.
• Team Interaction: May lead mid-sized projects; coaches and guides team members.