Clinical Documentation Specialist Auditor - Clinical Doc Integrity - Full Time 8 Hour Days Non-Exempt Non-Union

Clinical Documentation Specialist Auditor (CDS) performs review of inpatient medical records to identify documentation opportunities to accurately represent the severity of illness risk of mortality length of stay intensity of service and hospital quality metrics. Demonstrates proficiency on ICD10CM & PCS and respective coding guidelines & regulations for coding and reporting. Matter expert of key CDI hospital quality metrics and Inpatient Prospective Payment System (IPPS) documentation requirements for proper APR & MS DRGs assignment. The CDS Auditor functions at a higher level by leading and supporting the CDI team; and by active participation in physician/clinical staff engagement and education. Monitors internal key indicator metrics associated with CDI as it related to the revenue cycle and quality outcomes. Strategically audits cases in regard to Denial Prevention Quality comorbidities Risk Adjustment related data audits and Quality Assurance audits. Assists CDS in account reconciliation to ensure completeness of coding and documentation accuracy. Assists with denial management as it relates to documentation and appeals. Fosters teamwork & utilizes strong team building measures. Acts as consultant and educator to providers CDI and coding staff relative to clinical documentation and coding. Works with different specialties to ensure they are kept aware of changes.

Essential Duties:

• Directs and Educates Physicians/Residents and clinical staff on CDI process/goals and work in a collegial manner with physicians staff and consultants.
• Supports and helps with the daytoday operations of the team and help with the training of new employees or provides assistance when other team members need it.
• Involved in the clinical denial/appeal process for DRG challenges and clinical validations via Clinical Validation Audits/Denial Prevention reviewing technical payor denials and determines if an appeal is justified and author appeals.
• Performs various audits as assigned for denial prevention multiple quality comorbidities risk adjustment related data audits and quality assurance audits. Improves documentation through compliant physician query generation and provides education to providers and CDS.
• Achieves a physician response rate of 100 through CDI education of physicians identifying nonresponders and intervening as necessary. Follows the query escalation process when no response.
• Identifies opportunities to improve documentation through physician query generation. Practice the mnemonic MEAT (Monitored Evaluated Assessed or Treated) for building compliant and nonleading CDI queries. Applies evidencebased clinical criteria for clinical validation of diagnoses
• Utilizes the CDI software properly for tracking of CDI metrics and to assure compliance: documentation of pertinent clinical findings compliant/nonleading queries completion of all the required fields for data integrity and professional communication with coders and other staff members
• Conducts retrospective reviews for mortality quality metrics payment denials or other reasons when necessary
• Auditor acts as a subject matter expert and resource for the Clinical Documentation Specialists (CDS) coders and other departments as needed.
• May assume the role of CDS as demands for services requires entailing the following: Conducts new inpatient admissions reviews and proper working DRG assignment within 2 working days; Conducts follow up reviews and respective working DRG updates at least every 2 working days
• Support and collaborate with Clinical Documentation Improvement Manager Educator and Auditor CDS Manager and CDS Director with planning development and of audits root cause analysis solutions and education as needed.
• Assists department leader with accomplishment of department goals with other duties as assigned.

Required Qualifications:

• Req Bachelors Degree Graduate of an accredited school of registered nursing OR foreign medical graduate.

• Req 2 years Clinical documentation improvement experience
• Req 2 years Clinical experience in an acute care setting

Preferred Qualifications:

• Pref Certified Coding Specialist CCS (AHIMA)

Required Licenses/Certifications:

• Req Valid California Registered Nurse license or foreign medical graduate
• Req Certified Clinical Documentation Specialist (CCDS) Certified Clinical Documentation Specialist (CCDS from ACDIS) or Certified Documentation Improvement Practitioner (CDIP from AHIMA)
• Req Fire Life Safety Training (LA City) If no card upon hire one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin protected veteran status disability or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone ator by email at. Inquiries will be treated as confidential to the extent permitted by law.

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