Office Location: Newtown Square, PA with remote opportunities available
Versalus Health is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. Versalus Health has expanded its product offering to include DRG Revenue Integrity services. Versalus Health provides programmatic solutions for DRG compliance and revenue integrity by leveraging advanced analytics and DRG auditing and clinical expertise. Versalus offers outstanding growth opportunities, a competitive salary and benefits package including bonuses based on individual and company performance, and reimbursement for continuing education and association dues. Versalus has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!
The CDI Quality Measures Specialist acts as a liaison and advisor to our DRG Revenue Integrity clients to successfully integrate their CDI, inpatient coding, and quality measures improvement initiatives. Responsibilities include working closely with our client inpatient coding, CDI, Quality, Patient Safety, and physician leadership in identifying, aggregating, and reporting coded data and its impact on outcomes, comparative quality data, public reporting, and Value-Based Care success.
- Reviews and interprets information from the medical record and other data sources used to assess quality of care issues and identifies and addresses current documentation gaps to ensure accurately reflection of quality-related outcomes.
- Provides education to client staff and physicians on the importance of the Clinical Documentation Improvement (CDI) programs related to clinical quality and patient safety indicators.
- Facilitates modifications to clinical documentation through interactions with key client stakeholders to support accurate public reporting of patient acuity.
- Plans, compiles, analyzes, interprets, and produces data reports to disseminate quality-related information.
- Provides education to client IP Coding and CDI teams, providers, and other hospital staff regarding quality and patient safety topics, performance improvement, and other regulatory metrics and standards.
- Assists with the transformation of facts into actionable data and related analysis.
- Creates and delivers reporting documents, summaries, and presentations for tracking quality improvement activities.
- Acts as consultant and educator to client providers, CDI, and coding staff relative to clinical documentation and coding.
- Attends continuing education workshops, webinars, etc., for coding and documentation integrity quality and compliance.
- Perform other duties as assigned.
- RN/BSN with CDIP or CCDS required. CCS is highly preferred and may be required after one year of employment. (Assistance is available for preparation.)
- Extensive knowledge of clinical care operations, protocols, and best practices.
- Prefer experience working in a Level 1 Trauma Center and Academic Medical Center setting.
- Certifications and/or professional license must be maintained as a condition of employment.
- A minimum 5 years of hospital or vendor inpatient coding and/or CDI experience required.
Knowledge, Skills & Abilities:
- Quality Measures. Demonstrated knowledge of state and federal regulations, (AHRQ Quality Metrics, UHC Mortality Models, CMS Core Measures, and other national patient safety/quality indicators) relative to dissemination and use of clinical coding comparative data.
- ICD-10-CM/PCS. Proficient knowledge of coding conventions and use of coding nomenclature demonstrated knowledge of ICD-10 classifications, and thorough understanding of the effect coded data has prospective payment, outcome models, utilization, and reimbursement.
- Clinical Documentation Improvement. Proficiency with Clinical Documentation Integrity (CDI) concepts, practices, and processes.
- Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate audit results and correct, as necessary.
- Adaptability. Maintains effectiveness when experiencing changes in work tasks or the work environment; adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
- Initiative. Is proactive and self-directed. Shows initiative and responsibility in taking the necessary steps towards problem resolution. Is self-sufficient and does not need to rely on others to complete a job.
- Vivacity. Consistently maintains high levels of activity or productivity sustained over long working hours when necessary; operates with vigor, effectiveness, and determination.
- Performance. Meets or exceeds both production and quality expectations while performing complex medical record audits. Able to execute under pressure of time constraints and while managing multiple responsibilities.
- Planning and Organization. Proactively prioritizes initiatives, effectively manages resources and can multi-task. Actively manages their work assignments and seeks additional tasks when appropriate.
- Communication Skills. Communicates clearly, proactively, and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling, accurate, and concise rationales in support of findings and successfully crafts appeal letters with precise logic.
- Curious and Detailed Oriented. Actively seek out new ideas, possibilities, and answers to the tough questions. Pays meticulous attention to detail, identifies aberrant code assignment, mines medical records for all relevant and supporting evidence, intuitively understands appeal strategies and conscientiously follows all steps in the audit and appeals process. Committed to life-long learning.
- PC Skills. Demonstrates proficiency in Microsoft Office and Teams, WebEx, VPN access, navigating various EHRs, and ability to problem solve Internet connectivity issues.
- Enjoy work-life balance with a predictable schedule
- Compensation includes salary plus bonus opportunities
- Medical, Dental, Vision coverage, 401K
- Holidays, paid time off, short term and long-term disability insurance, and life insurance
- Reimbursement for continuing education and association dues
May be expected to sit at a desk for long hours. Must have a private and secure space to work, including a secure Internet connection. Repetitive movement of hands and fingers – typing and/or writing. Occasional standing, walking, stooping, kneeling, or crouching. Ability to reach with hands and arms, talk, and hear. Exert up to 20 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
Versalus Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law.