Driscoll Children's Hospital · 18 hours ago
Lead CDI Specialist
Texas, United States
Full-time
Onsite
Mid, Senior Level
3+ years expDriscoll Children's Hospital is a compassionate organization that values innovation and technology. They are seeking a Lead Clinical Documentation Improvement Specialist who will oversee the Clinical Documentation team, ensuring accurate documentation and coding while collaborating with various healthcare professionals. This role involves education, analysis of clinical documentation processes, and maintaining performance standards within the department.
Child CareChildrenHealth CareMedical
Responsibilities
Completes initial reviews/concurrent coding within 1 -2 working days in order to promptly identify potential documentation improvement opportunities
Conducts follow-up reviews/concurrent coding of patients every 2-3 working days to support and assign a working or final APR- DRG. Queries physicians regarding missing, unclear, or conflicting health record documentation
Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record
Collaborates with CDI Physician Champion, case managers, nursing staff, and other ancillary staff regarding interaction with physicians on documentation and to resolve physician queries prior to patient discharge
Participates in the analysis and trending of statistical data for specified patient populations to identify documentation improvement opportunities
Assists with preparation and presentation of clinical documentation monitoring/trending reports for review
Partners with the coding professionals when necessary to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to assign ICD-10-CM/PCS diagnosis and procedure codes to determine an accurate working and final APR-DRG, severity of illness, and/or risk of mortality
Ensure accuracy and optimization of quality initiatives such as Potentially Preventable Events, ICD-10, Data Governance, and future initiatives by performing concurrent/retrospective coding and CDI reviews and facilitating workflow
Reviews all mortality and PPE accts notified by CQA for coding documentation opportunities and communicates with QA dept as necessary
Assists other CDI Specialists with daily software, coding, workflow, and CDI questions as able
Communicates with CDI Champion as needed to discuss no response queries or obtain objective clinical perspective
Assist with retrospective coding review needed for statistical validation for external reporting entities such as STS, THCIC, and CHA
Ensure accuracy and optimization of quality initiatives such as Potentially Preventable Events, ICD-10, Data Governance, and future initiatives by performing reviews and facilitating workflow
Demonstrates a consistent level of performance and strives to maintain a steady level of productivity in all duties assigned
Assist HIM management with software implementation/testing/updates/support
Maintains utmost level of confidentiality at all times
Adheres to hospital policies and procedures
Demonstrates business practices and personal actions that are ethical and adhere to compliance and integrity guidelines
A teamwork approach, organization, problem-solving skills and flexibility are required
Demonstrates a thorough knowledge of computer applications and the ability to do research
Excellent interpersonal and communication skills required, professionalism is essential
Proficiency in the use of Microsoft applications (e.g. Word, Excel, PowerPoint), Epic, and 3M 360
Qualification
Required
RHIA, RHIT, or CCS with a minimum of three years hospital-based inpatient coding experience, or are clinical candidates credentialed as RN, LVN or BSN with a strong clinical background and a minimum of three years clinical experience in Pediatrics, Med-Surg, ICU, or Surgery
CCS coding certification required or CCS eligible- to be achieved within 1 year of employment
CDIP, or CCDS, eligible- to be achieved within 1 year of employment
A teamwork approach, organization, problem-solving skills and flexibility are required
Demonstrates a thorough knowledge of computer applications and the ability to do research
Excellent interpersonal and communication skills required, professionalism is essential
Proficiency in the use of Microsoft applications (e.g. Word, Excel, PowerPoint), Epic, and 3M 360
Preferred
RN, LVN or BSN preferred
Company
Driscoll Children's Hospital
We provide the absolute best pediatric care in South Texas, where care and community come together. Together, we heal.
1001-5000 employees
H1B Sponsorship
Driscoll Children's Hospital has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (12)
2023 (6)
2022 (4)
2021 (10)
2020 (8)
Funding
Current Stage
Late StageTotal Funding
$0.53MKey Investors
Toyota Motor
2024-09-26Grant· $0.53M
Leadership Team
Mary Peterson
Executive Vice President and COO
Recent News
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