Director Clinical Documentation Integrity

Location: Remote with occasional onsite travel required

Job Overview

The position is responsible for CDI program strategy and oversight. The Director will partner with the Senior Director, Clinical Revenue Cycle to strategically plan, organize, implement, and evaluate the CDI program. This includes management of case mix index (CMI), length of stay (LOS), Observed versus Expected mortality (O/E), in cooperation with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management, Quality and Physician advisors and leaders. The Director oversees the manager and clinical documentation specialists (CDSs) in planning, implementing improvements, and re-evaluating processes to keep staff engaged and to assist in meeting department goals

Tufts Medicine facilities include Tufts Medical Center, Lowell General Hospital, Lowell Saints Hospital and Melrose Wakefield Hospital. The Director of CDI serves as the programmatic and operational leader for Clinical Documentation. The Director works to leverage performance, provide feedback, and influence key stake holders to continually improve documentation results and impact key performance indicators (KPI) for the department and the health care system. The Director assists in leading continuous improvement in the development and deployment of standard policies, procedures, standardized queries, and technology.

Job Description

Minimum Qualifications:

1. BSN degree

2. Licensed as a Registered Nurse

3. Five (5) years relevant experience in the management of Clinical Documentation Integrity team

4. CCDS certification through ACDIS or CDIP Certification through AHIMA OR Other Comparable Certification

5. Three (3) years of experience in a health care facility that includes academic medical center

Preferred Qualifications:

1. Master's degree in healthcare administration, Health Information Management, Health Informatics, Nursing or other related field

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

Accountable for execution of program objectives including improving the accuracy of the medical record to facilitate an accurate case mix index (CMI), expected mortality rate and other quality metrics as well as meet goals for comorbidity rates, query rates, etc. Accountable for CDI success, including meeting key CDI metrics goals, such as query rates, capture rates, movement towards correct principal diagnoses, and CMI Provides strategic oversight of manager(s) and CDSs, helps develop a collaborative team, and manages multiple priorities simultaneously Manages, develops, and coaches the CDS team, motivating and supporting others in overcoming barriers to understanding Conducts select reviews of CDI queries and second level reviews to provide feedback Provides ongoing feedback to CDI team, physicians, administration, and CDI Executive Steering Committee Manages DRG mismatch process with CDS manager(s) and lead(s) and collaborates with Coding team on reconciling Oversees development of monthly educational topics for CDSs with CDS lead and manager(s) based on opportunities identified from second level reviews and query reviews Develops content and provides physician in-services as needed based on review of disagreed queries, ongoing opportunities, and physician process and outcome data Reviews regular reports and utilizes information to:

• Identify areas of focus and develop action plans to address
• Identify opportunities for CDS staff and physicians
• Strategize approach and process refinements to capture opportunity with the CDS team (prioritization, assignment, second level review focus, etc.)
• Track progress of CDI team in capturing opportunities and prioritizing workload effectively
• Use critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance
• Providing feedback on operational concerns and physician response issues to executive team

Partners with manager(s) to perform staff evaluations and provides feedback and conflict resolution to CDI team Works with manager(s) in conjunction with CDI and coding leaders to provide in-services and continuing education to the CDS team, physicians, and clinical departments, providing highly complex information to audiences with a varied level of understanding of severity of illness and risk of mortality in an effort to ensure optimal reimbursement Works closely with CDI physician advisors on solutions to various provider response issues Serves as a subject matter expert and authoritative resource on interpretation and application of CDI. Assumes personal responsibility for professional growth, development, and continuing education to maintain a high level of proficiency Participates in job interviewing, assessment, and selection of new employees Uses critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance Participates in query escalation process as needed

Physical Requirements:

Normal office environment

Skills & Abilities:

1. Excellent interpersonal and communication skills

2. Excellent organizational skills

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following CDI related duties: Facilitates improvement in overall quality, completeness, and accuracy of medical record documentation, obtains appropriate clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and coding staff to ensure that documentation reflects the level of service rendered to patients is complete and accurate, and serves as a resource to all team members on documentation guidelines, provides guidance and support as well as assisting in the education and training related to improving clinical documentation. A management role that supervises employees focusing on tactical, operational activities within a specified area, with the majority of time spent overseeing area of responsibility, planning, prioritizing and/or directing the responsibilities of employees. Goal achievement is typically accomplished through performance of direct and/or indirect reports. A role that directs a department or small unit that includes multiple teams led by managers and/or team Leaders. Responsibilities typically include: ownership of short to mid-term (1-3 years) execution of functional strategy and the operational direction of the Department, problems faced are often complex and require extensive investigation and analysis, and requires ability to influence others to accept practices and approaches, and ability to communicate and influence executive leadership.

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.