Nurse Risk Adjustment Jobs in Georgia (NOW HIRING)

Your job is more than a job

The Director, System CDI and Hospital Inpatient Coding is responsible for providing strategic leadership and operational oversight for the hospital's Clinical Documentation Integrity (CDI) program and Inpatient Coding functions. LCMC Health includes two academic medical centers, a children's hospital, six community hospitals, over 115 clinics, network of urgent cares and over 2800 physicians. This role ensures accurate and complete clinical documentation that reflects the severity of illness, expected risk of mortality, and complexity of care provided to patients, leading to appropriate reimbursement, accurate quality reporting, and improved patient outcomes. The Director will lead a team of CDI specialists and inpatient coders, fostering a collaborative environment, implementing best practices, and driving continuous improvement in documentation and coding processes.

GENERAL DUTIES

• Strategic Leadership:Develop, implement, and monitor the CDI and Inpatient Coding strategies in alignment with organizational goals, regulatory requirements, and industry best practices.
• Team Management & Development:Recruit, hire, train, mentor, and evaluate CDI specialists and inpatient coders. Foster a culture of excellence, professional development, and interdepartmental collaboration.
• CDI Program Oversight:
  • Manage and optimize the daily operations of the CDI program, including concurrent and retrospective review processes.
  • Develop and deliver education to physicians and other clinicians on documentation best practices,effective query writing, and the impact of documentation on quality, risk adjustment, and reimbursement.
  • Oversee the physician query process, ensuring queries are clear, concise, compliant, and lead to documentation specificity for accurate code assignment.
  • Monitor CDI metrics, identify trends, and implement interventions to improve documentation accuracy and completeness.
  • Proactively engage clinicians to ensure documentation accurately captures present on admission (POA) indicators for Hospital-Acquired Conditions (HACs) and Patient Safety Indicators (PSIs).
  • Educate providers on the importance of documenting comorbidities to accurately reflect Severity of Illness (SOI), Risk of Mortality (ROM), Elixhauser Comorbidity Index, and Hierarchical Condition Categories (HCCs) for appropriate risk adjustment and quality metrics.
  • Collaborate with Quality, Risk Management, and Case Management to ensure documentation supports patient care initiatives and reporting.

• Inpatient Coding Management:
  • Oversee the inpatient coding team, ensuring accurate and timely assignment of ICD-10-CM/PCS codes, CPT codes, and other necessary codes for billing and data collection.
  • Implement and maintain coding policies and procedures in compliance with AHA Official Guidelines for Coding and Reporting, CMS regulations, and other relevant payer requirements.
  • Monitor coding accuracy, productivity, and denial rates related to coding. Develop and implement action plans to address discrepancies.
  • Stay current with coding guidelines, regulatory changes, and industry updates, disseminating information to the team and adapting processes as needed.

• Compliance & Audit:
  • Ensure compliance with all federal, state, and payer-specific coding and documentation regulations.
  • Prepare for and participate in internal and external audits related to coding and documentation. Implement corrective actions as required.
  • Develop and conduct internal coding and documentation audits to identify areas for improvement and ensure data integrity.

• Interdepartmental Collaboration:
• Daily communication and collaboration with Quality, Risk Management, Physician Advisors, Medical Staff leaders, Nursing, Revenue Cycle,
• Compliance, and Information Technology departments to achieve CDI and coding objectives.
• Collaborate specifically with Quality and Risk Management teams to identify documentation gaps impacting publicly reported quality measures, PSIs, and HACs.
• Serve as a subject matter expert for documentation and coding, providing guidance and support across the organization.

• Technology & Systems:
  • Utilize and optimize health information systems, including Electronic Health Records (EHR), Computer Assisted Coding (CAC), and CDI software.
  • Advocate for and implement technological solutions to enhance efficiency and accuracy in CDI and coding processes.

• Reporting & Analysis:Generate and analyze data reports related to CDI impact (e.g., CMI, MCC/CC capture rates), coding accuracy, productivity, and financial performance. Specifically monitor and report on documentation's impact on SOI, ROM, PSI and HAC rates, and risk adjustment methodologies including Elixhauser and HCCs. Present findings and recommendations to leadership.

Qualifications:

Education: A bachelor's degree in nursing or a closely related healthcare field is required. Master's degree preferred.

Certifications:

• Registered Nurse is required.
• Certified Clinical Documentation Specialist (CCDS) or Clinical Documentation Improvement Practitioner (CDIP) required.
• Certified Coding Specialist (CCS) required.
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) preferred.

Experience:

• Minimum of 7-10 years of progressive experience in CDI roles within acute care multi-facility organization to include an academic medical center.
• Inpatient coding and/or CDI roles within an acute care hospital setting to include an academic medical center.
• Minimum of 5 years of leadership/management experience in CDI or inpatient coding.
• Extensive knowledge of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodologies, and healthcare regulations.
• Demonstrated understanding of quality metrics, patient safety indicators (PSIs), hospital-acquired conditions (HACs), risk adjustment methodologies (e.g., Elixhauser, HCCs), and their impact on hospital performance.
• Proficiency with EHR systems, CDI software, and coding encoders.

WORK SHIFT:

LCMC Health is a community.

Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little "come on in" attitude is the foundation of LCMC Health's culture of everyday extraordinary

Your extras

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits-all, think one-of-a-kind care.
• See opportunities, not problems - it's all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we do

You are welcome here.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

Simple things make the difference.

1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.

2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.

3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.

4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.