Manager of Clinical Documentation Integrity & DRG Denials - Omega Healthcare Management Services : Job Details

POSITION SUMMARY: Under the direction of the Director of Coding & Clinical Documentation Improvement, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials is responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, policies and procedures related to clinical documentation improvement for all Garnet Health hospitals. The Manager is responsible for leading CDI functions and overseeing the day to day work in the department. The Manager ensures that reviews of the patient's medical data are conducted to assess appropriateness and medical necessity for admission, and continued stay. The Manager facilitates improvement in the overall quality, completeness, and accuracy of medical record documentation. The Manager will evaluate denials and work closely with the outcomes manager and coding denial coordinator to oversee and write compelling, factual arguments when warranted to the third-parties denying claim.

POSITION QUALIFICATIONS:

Minimum Education:

• Bachelor's Degree in Nursing.

Minimum Experience:

• Minimum of five (5) years of progressive experience in an acute care hospital (larger than 100 beds).
• Minimum of five years of experience in the CDI industry.
• Strong knowledge of ICD 10 diagnosis coding, CPT Coding guidelines and DRG-based reimbursement knowledge, required.
• Exceptional ability to communicate effectively with physicians and other clinical professional staff.
• Knowledge of DRG and Coding appeal process.

Required Certification/Registration:

• Certified Clinical Documentation Specialist (CCDS) credentialed.
• Current license to practice as a Registered Professional Nurse in New York State required.