Mount Sinai Careers

Clinical Documentation QI Specialist II (Mount Sinai Hospital) Full-Time

New York, New York
Professional / Managerial / Administrative


Job Description

The Mount Sinai Health System

 

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The Mount Sinai Health System’s commitment to excellence extends beyond delivering world-class health care. The System’s ongoing success is dependent upon our highly motivated, nonclinical professionals working to improve business operations. Our leadership team is driven to provide exceptional service by cultivating a workforce that is dedicated to upholding Mount Sinai’s mission of delivering innovative, breakthrough medicine with compassion and integrity.

 

Are you ready to discover the world of limitless possibilities that comes with wearing the badge? Explore more about this opportunity and how you can help us write a new chapter in our story of unrivaled patient care!


What You'll Do:

The Clinical Documentation Quality Improvement Specialist II is responsible for improving the overall quality and completeness of clinical documentation; facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and medical records coding staff to ensure that documentation reflects complete and accurate level of service rendered to patients. 

Performance Requirement for CDQI Specialist II

1. Experienced CDQI with minimum 2-4 years recent experience in CDI role
2. To meet quality and quantity expectations within 6 months of employment. 
3. Quality review: ≥ 93%; 
4. Quantity: 12-15 Initial Chart reviews, >25% Query Rate.
5. Attains Clinical Documentation Specialist certification through ACDIS or AHIMA
6. The CDI specialist II also assists leadership in utilizing expertise in CDI and data analysis in evaluating CDI accuracy, standardizing review findings and reporting out results.
7. Works effectively and efficiently, able to work on several things at once while maintaining expected productivity outcomes. Meets established productivity goals without sacrificing quality.

Duties and Responsibilities:

  • Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through concurrent auditing and evaluation of the medical records.
  • Facilitates modification of clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a Diagnosis-Related Group (DRG) payer under Medicare.
  • Analyzes clinical status of patient, current treatment plan and past medical history to identify potential gaps in clinical documentation.
  • Assists in medical screening process, making referrals, interacting with case managers and clinical nurse specialists to ensure continuity of patient care as needed.
  • Updates the DRG worksheet to monitor any changes in status, procedures/treatments, and confers with physicians to finalize diagnoses. 
  • Proactively solicits clarification from physicians to ensure points of clarification have been recorded in the patient’s chart
  • Monitors activities to ensure that all clinical documentation is in compliance with State and Federal payer regulations.
  • Reviews clinical issues with coding staff to assign a working DRG.
  • Educates nursing staff, patient caregivers and coding staff on compliant documentation opportunities, coding and reimbursement issues as well as provides clinical expertise to the coding staff.
  • When scheduled, provides clinical documentation and billing compliance education which support Federal and State rules and regulations.
  • Performs other related duties.
Education and License Requirement:
  • Case Manager certification preferred CCA (Clinical Coding Analyst).  CCS (Clinical Coding Specialist_ or CCDS (Certified Clinical Documentation Specialist) preferred.
Experience and/or Skills Required:
  • Knowledge of ICD-9 and current Medicare and Medicaid regulations regarding clinical documentation and billing compliance for Part A and B services.
  • Demonstrated and interpersonal skills to work effectively with a variety of individuals and groups both internally and externally Ability to use basic data entry and retrieval systems Ability to follow up on issues and communicate effectively to appropriate personnel Willingness to seek opportunities for professional growth and to enhance current knowledge of billing compliance Excellent problem solving, organizational and analytical skills 
  • Demonstrated knowledge of ICD-9 codes, DRG and CPT coding Licensing License Licensing Agent Frequency Required 

 

Do you share our dedication to extraordinary service and have what it takes to wear the badge? Apply now!

 

 

Who We Are:

 

Over 35,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.

 

Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai Roosevelt, Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.

 

The Mount Sinai Health System is committed to the tenets of diversity and workforce that are strengthened by the inclusion of and respect for our differences. We offer our employees a highly competitive compensation and benefits package, a 403(b) retirement plan, and much more.

 

The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation.

 

EOE Minorities/Women/Disabled/Veterans