Houston, Texas

Work Shift: DAY

Work Week: M - F Specialized inpatient care for those patients requiring a longer hospital stay

  • Specialized inpatient care for those patients requiring a longer hospital stay
  • Outpatient physical and speech therapy
  • State-of-the-art diagnostic imaging such as X-ray, MRI, CT
  • Women’s Center with advanced mammography

Job Summary

Note: This position qualifies for relocation assistance of UP TO $5,000.00 (subject to terms & conditions).

At Houston Methodist, the System Clinical Documentation Improvement (CDI) Quality Reviewer is responsible for performing internal quality assurance reviews on Clinical Documentation Specialist (CDS) staff to ensure compliance with national guidelines and policies for complete, accurate and consistent reporting which results in appropriate reimbursement and data integrity. This position reviews outcomes that are communicated to the team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. Outcomes are communicated to the CDS team to provide specific education based on the quality monitoring review findings and trends. This position promotes a partnership between the concurrent clinical reviewers, medical record coders, and physicians to improve documentation and reimbursement.


HOUSTON METHODIST EXPERIENCE EXPECTATIONS

o Provide personalized care and service by consistently demonstrating our I CARE values:
- INTEGRITY: We are honest and ethical in all we say and do.
- COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
- ACCOUNTABILITY: We hold ourselves accountable for all our actions.
- RESPECT: We treat every individual as a person of worth, dignity, and value.
- EXCELLENCE: We strive to be the best at what we do and a model for others to emulate. 
o Focuses on patient/customer safety
o Delivers personalized service using HM Service Standards
o Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
o Intentionally rounds with patients/customers to ensure their needs are being met
o Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job


PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 10%
1. Acts as documentation liaison with Health Information Management, Case Management, ancillary departments, physicians, staff, and management. (EF)
2. Assists in ensuring Clinical Documentation Specialists (CDS) adherence with clinical documentation and coding guidelines and policies. (EF)

SERVICE - 20%
1. Serves as subject matter expert and clinical resource for CDS and coding staff to clarify and interpret medical record documentation for complete and accurate coding and DRG assignment. (EF)
2. Interacts and communicates with physicians and other providers as needed, educating them in the process of clarifying documentation in the medical record. (EF)

QUALITY/SAFETY - 40%
1. Ensures/Performs ongoing Quality Assurance reviews on each CDS based on Department Policies and Procedures and CDS Job Description, utilizing Training Manual, ICD-10-CM/PCS Coding Volumes, Coding Clinic, DRG Expert, AHIMA Compliant Query Guidelines and any other relevant sources and reports findings to leadership and staff. (EF)
2. Evaluates the monitoring tools and applies action plans specific to the outcomes to improve the program. (EF)
3. Supports the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes. (EF)
4. Evaluates the monitoring tools and applies action plans specific to the outcomes to improve the program. (EF)
5. Identifies special reviews or projects for review and clinical documentation improvement. (EF)

FINANCE - 20%
1. Promotes clarification of clinical documentation, advocating for appropriate reimbursement for the patient care resources consumed and the level of service rendered. (EF)

GROWTH/INNOVATION - 10%
1. Generates and communicates new ideas and suggestions that improve quality, service, or finance.
2. Maintains and applies up-to-date knowledge of official clinical documentation and coding guidelines, policies and procedures, and clinical/medical resources to assure knowledge and skills remain current. (EF)

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
 

EDUCATION REQUIREMENTS

o Bachelor of Science in Nursing is required; Master of Science in Nursing or other masters degree in a related field preferred;

OR

o Medical School graduate where Western Medicine is practiced
 

EXPERIENCE REQUIREMENTS

o Three years of recent clinical documentation experience in an acute care hospital required

o Academic hospital experience and coding experience preferred
 

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED

o For RN - Texas RN license or temporary TX RN license, should obtain permanent license within 90 days. Compact license acceptable according to current Board of Nursing requirements. Certified Coding Specialists preferred

o For Medical School graduate - Must have one of the following certifications:

o Certified Clinical Documentation Specialist (CCDS) through the Association of Clinical Documentation Improvement Specialists

o Certified Documentation Improvement Practitioner (CDIP) through the American Health Information Management Association

o Certified Coding Specialist (CCS) through the American Health Information Management Association
 

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.

o Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.

o Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.

o Demonstrates knowledge of DRG payor issues, appropriate DRG assignment alternatives, clinical documentation requirements, and referral policies and procedures

o Demonstrates accountability and professional development

o Requires excellent observation skills, analytical thinking, problem solving, plus good verbal and written communication

o Ability to interact and maintain regular significant contacts with other personnel throughout the institution (including but not limited to: physicians and their staff, mid-level providers, mid-level staff, coders, Case Managers); contacts methods may be in person, by telephone, or through correspondence

o Ability to display assertiveness while being even tempered, with a pleasing personality and the ability to communicate easily with others

o Working knowledge of Microsoft products including PowerPoint, Word, Excel and Outlook


Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of  race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor – priority referral Protected Veterans requested.



Company Profile

Houston Methodist Continuing Care Hospital is the first specialty hospital in the Houston Methodist family. Located in the heart of the Katy community, the facility provides a special menu of services for both inpatient and outpatient care by team members called to serve with excellence and compassion:

Houston, Texas

At Houston Methodist, Leading Medicine is more than a description of what we do; it's who we are. We take our responsibility as Houston's premier health care system seriously, and with a national reputation for excellence in patient care, innovation and research, we hold ourselves and the careers we build to a higher standard. Our culture is diverse, dynamic and challenging. We believe in our I Care Values and conduct ourselves with Integrity, Compassion, Accountability, Respect for others and a commitment to Excellence. Discover the difference for yourself and join Houston Methodist.

You can click on the video links below to learn more!

·  About Houston Methodisthttps://www.youtube.com/watch?v=ClN3mmKT0EI

·  Nursing at Houston Methodisthttps://www.youtube.com/watch?v=EUfmVeansTo

·  Houston - Best City to Live Inhttps://www.youtube.com/watch?v=MzLQzGBjHJw