About the position The Compliance Auditor – Clinical Documentation Integrity (CDI) is responsible for improving the overall quality, completeness and appropriate utilization of systems used to perform clinical documentation review and query functions for the South Texas Region. Compliance Auditor focuses on CDI compliance with the rules and regulations of regulatory agencies, compliance with South Texas Region/UHS policies and procedures through process of internal audits and denial reviews/audits. Promotes a partnership between the concurrent clinical reviewers, medical record coders, denials team and physicians to improve the accuracy of documentation and reimbursement for each facility. Supports and promotes the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes to reflect the patient’s true severity of illness, intensity of care, and risk of mortality. Responsible for internal audits, appeals, research on coding guidelines and/or regulations. Communicates with Regional CDI Manager, Regional Coding Manager, Supervisors and HIM management to accomplish hospital’s objectives. Educates members of the health care team on an ongoing basis regarding CDI compliance and new or updated coding clinics and assists with CDI concurrent review needs when needed. Position is a remote position with occasional need to work from the facility and/or attend meetings.

Responsibilities

• Perform internal audits, appeals, research on coding guidelines and/or regulations.
• Communicate with Regional CDI Manager, Regional Coding Manager, Supervisors and HIM management to accomplish hospital’s objectives.
• Educate members of the health care team on an ongoing basis regarding CDI compliance and new or updated coding clinics.
• Assist with CDI concurrent review needs when needed.
• Improve the overall quality, completeness and appropriate utilization of systems used to perform clinical documentation review and query functions.
• Focus on CDI compliance with the rules and regulations of regulatory agencies, compliance with South Texas Region/UHS policies and procedures through process of internal audits and denial reviews/audits.
• Promote a partnership between the concurrent clinical reviewers, medical record coders, denials team and physicians to improve the accuracy of documentation and reimbursement for each facility.
• Support and promote the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes to reflect the patient’s true severity of illness, intensity of care, and risk of mortality.

Requirements

• 3 to 5 years acute care inpatient CDI experience required
• Excellent written and verbal communication skills required.
• Auditing experience of acute care IP CDI required.
• Demonstrates ability to review all coding skills related to assignment of diagnosis, procedures and DRG’s
• Ability to read medical reports, interpret lab values pertinent to coding diagnoses, abstract pertinent information from records and to provide meaningful information by telephone or letter in replying to inquiries.
• Medical terminology, anatomy and physiology required.
• Computer skills and excellent customer service skills are required.
• Ability to recognize, analyze and resolve process problems.
• Flexibility of schedule and ability to work remotely.
• Must be able to provide high speed internet at place of residence at the expense of the employee, with a work area that is in adherence to privacy and security policies and procedures.
• Must demonstrate commitment and adherence to STHS’s Compliance Program and Code of Conduct through compliance with all policies and procedures, the Code of Conduct, attendance at required training and immediately reporting suspected compliance issue(s) to the Compliance Officer.

Nice-to-haves

• One to two years experience in leadership role, preferred.
• Advanced degree such as medical doctor or nurse practitioner acceptable/preferred.
• CCDS or CDIP Certification preferred.