DRG Clinical Documentation Educator

📋 Description

• • As a DRG Clinical Documentation Educator at Ensemble Health Partners, you will serve as a pivotal subject matter expert, dedicated to elevating the quality and accuracy of clinical documentation across our healthcare system. Your primary mission will be to educate, train, and refine processes in collaboration with leadership to ensure that clinical documentation accurately reflects the severity, acuity, and risk of mortality of patients, leading to the most precise Diagnosis Related Group (DRG) assignments.
• • You will be instrumental in developing and implementing comprehensive onboarding programs for all new Clinical Documentation Specialists (CDSs), providing them with the mentorship and education necessary to excel. This includes leading and coordinating training sessions, and working closely with CDI leadership and other clinicians to ensure orientation content, educational materials, and training programs remain relevant and effective.
• • A key responsibility will be to formulate and deliver customized education tailored to various healthcare professionals, including CDSs, coders, physicians, mid-level providers, nursing staff, dietary teams, and quality improvement personnel. This education will be delivered through both one-on-one mentoring and group training sessions, fostering a culture of continuous learning and improvement.
• • You will actively identify opportunities for documentation improvement and recommend strategies for effective physician queries to ensure that the full scope of patient care, including intensity of services, is accurately captured within the medical record.
• • A deep understanding of clinical documentation's impact on key performance indicators is essential. This includes demonstrating a thorough grasp of complications, co-morbidities, severity of illness (SOI), risk of mortality (ROM), case mix index (CMI), secondary diagnoses, and how various procedures influence final DRG assignments.
• • You will educate members of the CDI team and providers on the review functions within the CDI program, ensuring alignment with enterprise goals, regulatory compliance, and established policies and procedures. This includes assisting in the development and maintenance of system-wide CDI policies and procedures, and staying abreast of the latest CDI guidelines and best practices.
• • Ensuring program compliance with all relevant coding guidelines and coding clinics is paramount. You will remain current with coding information to guarantee the accuracy of codes assigned based on the documentation provided.
• • You will act as a primary resource for accurate and ethical documentation standards, as well as regulatory requirements, providing guidance and support to all stakeholders.
• • A critical skill will be the ability to draft compliant queries, adhering to best practices endorsed by organizations like AHIMA and ACDIS, to elicit necessary clinical documentation.
• • You will conduct thorough medical record reviews to assess completeness and accuracy, specifically focusing on the capture of severity of illness, risk of mortality, and clinical validation.
• • You will evaluate whether professionally recognized standards of quality care are being met through the documentation.
• • As needed, you will audit the performance of CDSs to ensure system objectives are met, developing individualized educational plans based on Quality Audit (QA) outcomes and providing one-on-one mentoring to support their professional growth.
• • You will oversee and coordinate SMART-related education, meetings, and requirements for the department, as directed by the SMART department, ensuring seamless integration and execution.
• • This role requires a proactive approach to identifying and addressing documentation gaps, contributing directly to the financial health and operational efficiency of the organization by ensuring accurate reimbursement and compliance.
• • You will be a champion for best practices in clinical documentation, influencing positive change and driving excellence across the organization.
• • Your expertise will be crucial in navigating the complexities of healthcare regulations and reimbursement methodologies, ensuring Ensemble Health Partners remains at the forefront of the industry.
• • You will contribute to a collaborative environment, working effectively with diverse teams to achieve shared goals in revenue cycle management.
• • The ability to translate complex clinical and coding concepts into understandable educational content for various audiences is key to success in this role.
• • You will play a vital role in maintaining and enhancing the reputation of Ensemble Health Partners as a leader in revenue cycle management solutions.