Mount Sinai Careers
Clinical Documentation QI Specialist I-- Mount Sinai Health Partners
The Mount Sinai Health System
Mount Sinai is one of the largest non-profit health systems in the U.S. with a strong reputation for quality of care (18th ranked academic medical center) and research/education (22nd ranked medical school). Our health system has ~40,000 employees working together to provide billions of dollars in high-quality care for millions of patients each year.
We are accelerating a transition to a business model focused on population health management – our goal is to keep entire communities healthy and out of the hospital. Mount Sinai Health Partners (MSHP) is the team driving this transformation within Mount Sinai. The team includes 400+ employees with clinical, contracting, finance, IT, analytics, operations, and product development expertise.
MSHP is a fast growing business unit within Mount Sinai and is looking for team members who:
· Are comfortable “playing up” and “playing down” as needed to accomplish business objectives
· Work productively amidst ambiguity
· Thrive in fast-paced work environments
· Seek to improve the status quo
Within MSHP, the Ambulatory CDQI team helps ensure accurate, timely, and quality clinical documentation in the medical record to reflect the health status of patients and the care they receive. CDQI specialist are responsible for retrospective reviews of electronic health records for conflicting, incomplete, or nonspecific provider documentation as it relates to appropriate HCC code capture.
MSHP seeks a Clinical Documentation Specialist will support efforts to improve the overall quality and completeness of clinical documentation in outpatient physician practices. He/ She will work closely with physicians, Health Information Management and the Mount Sinai Health Partners team to review and code ambulatory medical records, identify opportunities to improve coding, educate physicians, and act as a liaison between all parties.
· Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation
· Reviews charts to assess the clinical status of patients, current treatment plan, and past medical history to identify potential gaps in clinical documentation related to outpatient encounters, with a particular focus on primary care visits.
· Performs on-site or electronic coding and clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding. A particular focus with be on Hierarchical Condition Categories (HCC) coding, which is used by CMS and other payers to determine illness complexity and estimate patient risk of future health care utilization.
· Leverages data provided by available information technology (such as billing data) to identify additional opportunities to improve the comprehensiveness and specificity of outpatient coding
· Communicates and coordinates chart reviews with physician office staff and distributes correspondence (“CDQI alerts”) related to review.
· Analyzes returned CDQI alerts for accuracy and completeness
· Reviews outpatient visit diagnoses and service levels prior to claim submission to ensure they accurately reflect the clinical status of patients and the type of care delivered
· Proactively solicits clarification from physicians to ensure key aspects of care have been appropriately recorded in the patient’s chart
· Participates in data acquisition, development of performance reports and communication of results to physicians, practice managers, and the CDQI leadership team
· Interacts regularly with physicians, particularly primary care providers, in the outpatient setting, providing ongoing education regarding compliant documentation and accurate coding, and serves as clinical liaison to the coding department
· Identifies training needs, prepares summary reports and conducts coaching as appropriate for clinicians and other staff to improve the quality of the documentation to accurately reflect members’ health status.
· Monitors coding changes by governmental agencies and other payers; educates practices on coding and compliance issues
· Monitors activities to ensure that all clinical documentation is in compliance with State and Federal payer regulations
· Performs other related duties.
Education and Experience
· High school diploma or general education degree (GED); or equivalent
· Must have a minimum of 3 years coding experience
o At least 1 year of HCC Risk Adjustment experience, preferred
o Clinical background in a healthcare setting, preferred
· Credentials in one or more of the following, required:
o Certified Coding Specialist (CCS)
o Certified Risk Adjustment Coder (CRC)
o Certified Professional Coder (CPC)
Additional Skills and Qualities
· Demonstrated experience with front-end process improvement initiatives
· Thorough knowledge of ICD-9-CM, ICD-10, CPT, and HCPCS
· Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements
· Familiarity with APC coding
· Experience with Microsoft Excel and Access
· Strong communication and mentoring skills
· Ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization
· Strong time management skills
· Excellent organization skills
· Must possess high degree of accuracy, efficiency and dependability
· Excellent written and oral communication for representation of clear and concise results