Note: The job is a remote job and is open to candidates in USA. Wellstar Health System is a prominent healthcare organization dedicated to enhancing the health and well-being of individuals. They are seeking an Executive Director of Clinical Documentation Improvement to oversee the CDI Program, ensuring accurate clinical documentation and promoting effective review processes. The role involves collaboration with various healthcare teams and leadership in maintaining compliance and operational excellence within the department.

Responsibilities

• Develops and manages the Documentation Improvement Department initiatives
• Oversees the daily operations of the acute care and WellStar Medical Group CDI departments
• Ensures successful execution of strategies that contribute to system goals: a) Proficient in translating complex systems into key initiatives and executing with effective change management and stakeholder engagement
• B) Must possess skills required to run a fiscally responsible program while ensuring constant improvement and demonstrating return on investment, value added from program
• C) Extensive knowledge of treatment and documentation methodologies, electronic medical record (EMR) and other technology capabilities, data collection and reporting techniques, and coding and classification systems
• D) Maintain expertise in various regulatory, guideline and quality criteria and requirements related to quality, coding, billing and clinical documentation
• E) Demonstrated ability to provide leadership and direction to Documentation Department Staff and coding specialists with relation to Clinical Documentation issues and establishes programs for the team to ensure compliance with productivity & quality standards
• F) Knowledge of insurance regulations and Medicare and Medicaid guidelines, ACO and other payment models, Vizient and other quality algorithms and criteria
• G) Develop and manage to departmental budgets
• H) Ensure that the key metrics related to documentation improvement such as CMI are on target and explainable
• Identify Clinical Documentation opportunities to collaborate, educate, and improve in order to achieve strategic goals
• Take the lead on communication and documentation improvement initiatives with physicians, nurses, coding, quality, billing and other members of the health care team, working independently to resolve such issues
• Lead performance improvement initiatives in the areas of opportunity to improve documentation tools and clinical data
• Subject Matter Expert in data analysis and clinical documentation to help teams determine root causes
• Determines trends and helps create action plans based on internal and external data such as PEPPER, Vizient, financial reports, etc
• Internal Coding Audit Data
• Coding Educator Data
• Coding Quality Manager Data
• Develop & Oversee Audit Programs & Ensure the Accuracy of External Reporting Through Implementing Data Quality Programs for: a) Risk Adjustment Factor-Based Payments (i.e., shared savings) b) ACO Payments c) Vizient, Leapfrog d) Accurate payment with all other payors within scope
• Oversee coding and data quality educational program based on the action plans and identified needs. Working with a broader audience, med staff committees, service lines, Business Intelligence, etc
• Performs other duties as assigned
• Complies with all Wellstar Health System policies, standards of work, and code of conduct

Skills

• Bachelors Health Information Management or Bachelors Nursing or Masters Other-Preferred
• All certifications are required upon hire unless otherwise stated
• Minimum 10 years of progressive healthcare experience with at least five (5) years of CDI, nursing or HIM leadership experience
• Advanced clinical expertise and extensive knowledge of complex disease processes, clinical data analysis and reporting and acute care, medical group and health plan experience
• Skill in identifying problems and recommending solutions
• Skill in preparing and maintaining records and written reports
• Skill in establishing and maintaining effective working relationships with physicians, hospital staff and vendors
• Ability to interpret, adopt, and apply guidelines and procedures
• Ability to analyze complex scenarios and apply critical thinking
• Extensive knowledge of reimbursement systems
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation and coding

Company Overview

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