Clinical Documentation Integrity Specialist

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

Duke Nursing Highlights:

• Duke University Health System is designated as a Magnet organization
• Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 Nurses.
• Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
• Duke University Health System has 6000 + registered nurses
• Quality of Life: Living in the Triangle!
• Relocation Assistance (based on eligibility)

Occ Summary

Communicates with and educates physicians, mid-level providers, patient resource managers/case managers, Hospital Information Management (HIM) Compliance Specialists, and other health team members to facilitate improvement in comprehensive and inpatient medical record documentation to reflect conditions present on admission, diagnoses, complications/comorbidities (CCs), and the clinical treatment plan for inpatients. Work Performed Rounds with the physician team and completes a review of the medical record for all Medicare, Medicaid, and self-pay patients and creates a clinical documentation record. 

Communicates with physicians to clarify information, obtain needed documentation, present opportunities for mentorship, and educate for appropriate Diagnosis-Related Group (DRG) based on severity of illness. Follows up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with HIM to develop physician education strategies to promote complete and accurate clinical documentation and correct negative trends. Provides educational sessions to physicians/physician assistants. Demonstrates an understanding of CCs, severity of illness, risk of mortality, case mix, secondary diagnosis, and impact of procedures on DRG and can impart this knowledge to physicians and other health team members. Utilizes the appropriate clinical documentation system to identify opportunities and ensure accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes. 

Assists with the completion of CDI retrospective documentation through meetings with physicians/other clinicians for query response and/or documentation clarification. Identifies the most appropriate principal diagnosis and CCs to accurately reflect the severity of illness. Processes discharges by assigning and updating a working DRG and collaborates with HIM as necessary to ensure that the final DRG assignment is reflective of the optimal DRG, which reflects resource allocation. Acts as a consultant to Hospital Information Management (HIM) to assign the correct DRG. When contacted by Hospital Information Management (HIM) Compliance Specialists concerning disagreements about DRG or incomplete documentation, reviews medical records and follows physicians, if appropriate, promptly. Works with Hospital Information Management (HIM) Compliance Specialists to ensure AR days remain in the targeted range. Review the chart with CodingManager and/or the immediate supervisor if unable to reach an agreement with Hospital Information Management (HIM) Compliance Specialists. Reviews inpatient medical records both concurrently and retrospectively for identified services and payer populations.

Reviews all Medicare/Medicaid and self-pay patients at the time of admission to verify the written admission order (IP, OBS, OPS) for accuracy by the utilization management plan and takes appropriate action to ensure congruence and compliance with DUH and federal regulations. Ensures that orders are reflective of the patient's level of care, severity of illness, and intensity of service, utilizing set criteria. Communicates and collaborates with the DUHS billing entity (PRMO) to ensure that all admission orders written are accurately reflected in the billing system to ensure accuracy and congruence between the clinical and billing systems. Provides feedback via formal and informal education to physicians that will improve processes and compliance with the utilization management plan. Provides ongoing utilization review for private payors for identified services, i.e., inpatient psychiatry and the pediatric and adult bone marrow transplant units. Collaborates effectively with reviewers from third-party payors to ensure positive working relationships and avoid denials for payment contrary to medical necessity or lack of information during the concurrent admission. Provides on-call support to the DUH Emergency Department (ED) to support the accuracy and timeliness of ED physicians. Support nurses/physician extenders in the determination and assignment of patient status.

Provides education to ED physicians/physician extenders via informal and formal education sessions to ensure understanding of status to ensure compliance with the Utilization Management Plan. Perform other related duties incidental to the work described herein. Knowledge, Skills, and Abilities Prior case management/utilization review experience and/or training. Advanced communication and interpersonal skills with all levels of internal and external customers. Excellent written/verbal communication, critical thinking, creative problem solving, and conflict management skills. Proficient organization and planning skills. Strong computer skills. Demonstrated knowledge of quality improvement theory and practice.

Minimum Qualifications

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy-related conditions), sexual orientation, or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Each hiring department will provide additional information and provisions for requests for reasonable accommodation.

Education

BSN or PA (Physician 's Assistant) or NP (Nurse Practitioner) orDoctorate degree in a medical lyrelated field required.

Experience

Three years of progressive healthcare experience in an acute care setting. Previous chart review experience (case management utilization preferred). Excellent written/verbal communication, critical thinking, creative problem-solving, and conflict management skills, in addition to proficient organization and planning skills, are required. Demonstrated knowledge of quality improvement theory and practice.

Degrees, Licensures, Certifications

Currently licensed and/or registered as a professional nurse/physician assistant/MD in the state of North Carolina, preferred. CCDS, CCS, or CDIP preferred.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.