Assistant Director of CDI (Assistant Director of Fiscal Affairs), Clinical Coding & Coding Quality

Empower Every New Yorker - Without Exception - to Live the Healthiest Life Possible

NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

Under the direction of Revenue Cycle Services, performs secondary level review to facilitate and obtain appropriate physician documentation for clinical conditions or procedures to support the appropriate severity of Illness, expected risk of mortality, and complexity of patient care and to optimize reimbursement, ensuring patient-centered quality care, optimal utilization of resources, service delivery and compliance with NYC Health + Hospitals, hospital, and all relevant regulatory policies, procedures, and standards of care for better outcomes and improved patient experience. Identifies educational opportunities for and provides feedback to facility clinical documentation specialists.

This position also monitors facility departmental and interdisciplinary documentation performance, participates in performance improvement and research activities; maintains professional practice standards and clinical expertise; and demonstrates leadership skills. Demonstrates effective communication, planning, and organizational skills and keeps current knowledge in the clinical documentation field and all applicable

General tasks and responsibilities will include:

Performs retrospective reviews to identify appropriate physician documentation and missed query opportunities for any clinical conditions or procedures through extensive on-going interaction with facility CDIs, DRG Validators and coding staff to ensure the clinical documentation properly captures information describing patients' acuity, severity of illness, and risk of
Mortality; reflects the level of service delivered to patients is appropriate, complete, and accurate; and supports appropriate reimbursement for the level of service rendered to all patients.

Performs retrospective reviews of focused DRGs to evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, post-admission complications and procedures for accurate Diagnosis-Related Group (DRG) assignment and Case Mix Index (CMI), risk of mortality, and severity of illness. - Mortality etc.

Reviews Patient Safety Indicators and Hospital Acquired Conditions for appropriate reporting and identifies opportunities for provider education to support accurate reporting of quality metrics in collaboration with the Patient Safety and Quality departments.

Participates in the denials and appeals process by reviewing cases denied and making the determination whether or not a case is appealable by using pre-established criteria, based facility policies and procedures. Provides feedback to facility CDIs and physician advisors on opportunities.

Contributes to the strategic planning and process improvement initiatives and activities related to clinical documentation, by providing expert-level review and assessment, and effective recommendations or solutions for improvement.

Assists in the development of policies, procedures, and guidelines, or a review and/or revision of existing ones, to support best practices for clinical documentation program and staff; ensures all compliance and regulatory standards are met.

Collaborates and educates facility Clinical Documentation Improvement leads on validation practices and metrics.

Queries physicians for incomplete, inconsistent, unclear or conflicting health record documentation to clarify and resolve conflicting information in patient's medical record; maintains a record of review and query activities and other appropriate records.

Identifies and reports areas of weakness that may impact financial opportunities, and works with Finance or other appropriate staff in resolution of problems.

Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement and provide feedback to the program lead.

Assists with preparation and presentation of clinical documentation monitoring/trending reports for review with physician advisors and leadership.

Participates in the orientation and training of new staff members, and provides continual guidance and mentoring, as required.

Educates providers on proper clinical documentation and coding guidelines and practices, and compliance and reimbursement issues on an ongoing basis.

Attends and/or participates in staff, departmental and interdisciplinary meetings, LEAN efficiency/process improvement events, training and quality assurance/performance improvement (QA/PI) activities.

Acts as a liaison and key resource for medical and other appropriate staff on interpretation and application of clinical documentation, ethical reporting and documentation standards and other related actions and matters; actively monitors clinical documentation requests and responds to questions submitted; provides complete follow-through on all requests for clarification.

Participates in outpatient clinical documentation review on emergency, ambulatory surgery and ambulatory care visits to identify documentation opportunities to support accurate reporting of HCCs, HEDIS/QUAR, CRGs and providing education to the care team.

Performs other related work, as assigned.

Minimum Qualifications
1. Master's degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and two (2) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, one (1) year of which must have been in a responsible administrative or managerial capacity; or
2. Bachelor's degree from an accredited college or university in disciplines, as listed in "1" above; and three (3) years of experience, as described in "1" above, one (1) year of which must have been in a responsible administrative or managerial capacity.

Department Preferences

• Must have at least 2 years' experience as a DRG Validator with a minimum of 3 years' experience coding in an acute care setting.
• Knowledge of EPIC EMR and Financials
• Knowledge of 3M360 products and software
• Computer literacy required including working knowledge of relevant software packages such as Microsoft Office

Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED); and, Bachelor of Science in Nursing degree from an accredited college or university; and, four (4) years of acute care experience; or

Valid New York State license and current registration to practice as a Nurse Practitioner (NP) issued by the NYSED; and, two (2) years of experience,

Valid New York State license and current registration to practice as a Physician Assistant (PA) issued by the NYSED; and, two (2) years of experience

Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or,

Successful completion of education that leads to a medical degree; and, two (2) years of experience

• Possession of a Registered Health Information Administrator (RHIA)(RHIT)credential from AHIMA and two (2) years of satisfactory experience in coding and abstracting medical
  records in a recognized hospital or healthcare organization, of which one (1) year has been in a supervisory and/or administrative capacity; or
• Possession of a valid certificate as a Certified Coding Specialist (CCS) from AHIMA and five (5) years of satisfactory experience in coding and abstracting medical records in a recognized hospital or healthcare organization, of which three (2) years have been in a supervisory and/or administrative capacity; or

If applying online, please include your cover letter in the same file attachment with your uploaded resume.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs