CLINICAL DOCUMENTATION INTEGRITY SPEC

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)

This position may have the opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC

This position will be responsible for utilizing their clinical and nursing knowledge and understanding of current CMS coding guidelines, conventions, and, AHA coding clinics to improve the overall quality and completeness of the patient's medical record. Through a multidisciplinary team process, the ambulatory CDI specialist performs pre-visit and retrospective reviews of ambulatory clinical documentation to ensure an accurate depiction of the true complexity of the patient. This includes compliant documentation to support the capture of hierarchical condition categories (HCC), ICD-10-CM accuracy and specificity, and medical necessity. They work collaboratively with ambulatory physicians and advanced practice providers to communicate opportunities and educate members of the patient care team regarding documentation guidelines, coding requirements, and,service-line-specific requirements. They also communicate with coders, compliance specialists, and/or clinical documentation analysts regarding document clarification and accurate coding, as needed. Participates in select committees and provides education programs as necessary.

(25%) 1. Medical Record Review: Performs pre-visit and retrospective reviews to ensure appropriate clinical documentation to support hierarchical condition categories, ICD-10-CM specificity, and the medical necessity of ambulatory visits. Follows ambulatory CDI processes for performing medical record reviews, identifying opportunities to improve provider documentation, and querying physicians as needed to ensure that appropriate documentation appears in the medical record. Consistently meets established productivity targets for record review.

(20%) 2. Competency: Demonstrates knowledge of documentation requirements and coding guidelines that pertain to outpatient diagnosis coding to accurately reflect the complexity and medical necessity of the visit. Analyzes the clinical status of patients, the current treatment plan, and past medical history and identifies potential gaps in the physician's documentation. Maintains a level of practice demonstrating knowledge and understanding of outpatient query standards and knowledge of compliance and regulatory agency expectations.

(20%) 3. Education: Routinely provides education to physicians, advanced practice providers, and other key healthcare providers regarding the need for accurate, specific, and complete clinical documentation in the patient's medical record. Delivers provider-specific metrics and coaches providers on problem lists and RAF gap-closing opportunities as needed.

(20%) 4. Collaboration: Collaborates effectively throughout the organization by developing collegial relationships, communicating information effectively, encouraging communication, and serving as a resource to staff and other departments. Communicates with the clinic and coding staff as needed regarding documentation concerns and assists with resolving queries. Reviews data and trends to help identify opportunities, offer solutions and participate in their resolution.

(10%) 5. Professional Growth and Development: Demon strategizes responsibility and accountability for personal development by participating in continuing education offerings. Maintains competence related to HCC documentation requirements, ICD-10-CM code assignment, and codifying guidelines. 

(5%) 6. All other duties as assigned.

BSN, PA (Physician's Assistant), NP (Nurse Practitioner), or doctorate in a medically related field is required.

Three years of progressive healthcare experience in an acute care setting. Previous chart review experience (case management utilization review) is preferred. Excellent written and 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.

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

Duke is an Affirmative Action/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, sexual orientation, or veteran 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 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 essentialjob 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.