Covenant Health

Manager - Clinical Documentation Improvement (CDI)

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Medical Group is Covenant Health’s employed and managed medical practice organization, with more than 300 top Physicians and providers spanning the continuum of care in 20 cities throughout East Tennessee. Specialties include cardiology, cardiothoracic surgery, cardiovascular surgery, endocrinology, gastroenterology, general surgery, infectious disease, neurology, neurosurgery, obstetrics and gynecology, occupational medicine, orthopedic surgery, physical medicine and rehabilitation, primary care, pulmonology, reproductive medicine, rheumatology, sleep medicine and urology.

Position Summary:

The Manager of Clinical Documentation Compliance develops, implements and oversees all activities of daily operations and supervision of employees for the Covenant Medical Group (CMG) clinical documentation improvement department. This program supports accurate physician documentation for medical necessity, coding and billing of clinical services. 

This position requires a unique skill set including extensive computer and MIS expertise (at a conceptual level) including, but not limited to: computer systems and software, information security, healthcare systems, data quality, protection of patient privacy, data display, design, linkage, and archiving/retrieval of information.  Monitors the following to ensure facility goals are met and to prevent delays that affect CMG’s financial performance: all unbilled accounts receivable claims for all coding deficiencies including those claims that have failed edits and are in need of correction. The position ensures that the documentation process meets regulatory guidelines and standards. 

Instills an equal appreciation in CDI personnel for complete and accurate information and the financial and clinical ramifications of all work processes. Responsible for ensuring practices in the department to meet all regulatory and state standards.  Works closely with IS on system selection and implementation that affect the area.  Maintains optimal communication links with Integrity Office, Coding/Transcription, Quality Management and CBO (Centralized Billing Office).  Customer service mentality is crucial, as is a good working relationship with the medical staff.

Responsibilities include interviewing, hiring and training new employees; and developing a consistently reliable service that adheres to quality, budget, and timeliness. Establishes and monitors individual employees’ quality and quantity standards assuring these standards are consistently met.  Develops, and ensures adherence to enterprise-wide policies, procedures, guidelines, and training manuals. Establishes, implements, and enforces standards for quality and timeliness based on customers' needs and in accordance with HIPAA, CMS and other related State and Federal guidelines.

The Manager of CDI has responsibility for the documentation accuracy to meet coding guidelines and medical necessity for payor authorizations as well as regulatory and organizational requirements.  This position must work directly and indirectly with CMG’s providers to assure accurate and timely documentation of the patient’s condition and diagnosis, since the Clinical Documentation Management services are crucial to the cash flow of Covenant and have a direct impact on Covenant’s financial performance.

Recruiter: Sarah Grey || sgrey1@covhlth.com || 865-374-5271

Clinical Documentation:

• Develops, implements and evaluates a system-wide clinical documentation improvement (CDI) program that ensures compliance with medical necessity and coding documentation to assure correct reimbursement for the clinical services provided.
• Directs a centralized clinical documentation operation to service the Physician documentation in the physician office settings and acute care entities of Covenant Health, which includes the oversight, planning, and maintenance of daily activities and special projects as necessary to achieve and maintain business objectives.
• Develops departmental policies and procedures, objectives, quality assurance programs and safety standards.
• Oversees the planning direction and supervision of all clinical documentation improvement activities.
• Monitors the various reports to assure re-direct staff work processes to meet goals set relative to CDI annual expectations and payor and regulatory denials.
• Annual operating and capital budgeting.
• Monitors for changes in Coding laws and regulations, and assures that any necessary revisions are made to the policies, procedures, queries and documentation guides in a timely manner.
• Conducts special departmental studies in which clinical documentation and reimbursement problems are identified.  Makes recommendations for improvement and monitors compliance with recommendations.
• Oversees the development and implementation of the continuing education programs for the CDI, coding and medical staffs, providing direct and indirect training programs for the system medical staff and monitoring compliance.
• Participates in CMG Revenue Cycle Teams and provides regular clinical documentation feedback on program objectives.
• Works closely with CBO, RAC and Coding personnel to assure that close linkages is maintained with special reference to billing and collection issues. Works on identified issues relative to denials of payment, as it relates to coding.
• Local travel required.
• Other duties as assigned.

Quality:

• Identifying quality issues related to clinical documentation.
• Works with facility medical staff Quality and UM committees to identify and address documentation issues that impact physician practice and hospital quality standards.
• Stays abreast of national quality trends and identifies clinical documentation elements that will need incorporation in care designs.
• Provides a direct clinical documentation quality link with case management function.
• Other related duties as assigned.

Minimum Education:           

Bachelor degree or an equivalent combination of post-secondary education and directly applicable professional experience is required.  Knowledge of CPT, HCPC and ICD-10-CM coding, third-party regulations and managed care practices required.

Minimum Experience:          

Three (3) years supervisory experience in related health field required, acute care experience preferred. Familiarity with the Joint Commission, state and financial regulatory approach mandatory, as well as hospital finance, needed. A minimum of five (5) years experience in documentation/coding compliance auditing and/or case management with specific experience in CDI required.  Must be able to work independently and as a team member.  Possesses a strong work ethic.  Must demonstrate excellent written and oral skills.

Licensure Requirements:     

Certified Professional Coder (CPC) or Certified Professional Medical Auditor (CPMA preferred). Employee must have a valid Tennessee driver’s license Class D and state mandated minimum insurance coverage.  Driving record must meet Covenant Health minimum standards at the date of hire and throughout employment tenure.