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AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better.

**Shift** : Full-time; Monday-Friday

**Job Location** : Onsite, Altamonte Springs, FL

The role you will contribute:

Under general supervision of the Clinical Documentation Integrity (CDI) Manager, and in some situations the supervision of the Director of Clinical Documentation Integrity, and in collaboration with physicians, nursing and HIM coders. The CDI Quality & Compliance Team Leader strategically facilitates and obtains appropriate and quality physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient. educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, care management and quality abstracters. The Quality Auditor Manager adheres to strict departmental and organizational goals, objectives, standards of performance and policies and procedures, continually ensuring quality documentation and regulatory compliance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you will bring to the team:

+ Demonstrates, through behavior, Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork

+ Completes accurate and timely record review to ensure the integrity of clarification compliance for all CDSs throughout all facilities on a quarterly basis through audit process

+ Completes accurate and concise input of audits to provide feedback to CDI Market Leaders

+ Performs quality reviews of the medical record for compliance including completeness and accuracy for severity of illness (SOI) and quality performance measures. Quality reviews consist of, but are not limited to; concurrent, mortality, Retrospect and other internal CDI audits to ensure compliance to guidelines.

+ Understands and supports documentation strategies (upon completion of training) and continues to educate self and team members using educational tools, videos and provided WebEx’s.

+ Recognizes opportunities for documentation improvement using strong critical-thinking skills. Uses critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance.

+ Transcribes documentation clarifications as appropriate for SOI, ROM, PSI, HCCs and HACs to ensure documentation compliance is accomplished.

+ Strategically educates members of the patient-care team regarding documentation regulations and guidelines, including attending physicians, allied health practitioners, nursing, and care management. This includes quarterly compliance updates from Medicare.

+ Effectively and appropriately communicates with physicians and other healthcare providers as necessary to ensure appropriate, accurate and complete clinical documentation. Communicates with HIM staff and collaborates with them to resolves discrepancies with DRG assignments and other coding issues.

+ Leads out on CDI projects as project manager, strategically planning and implementing the project through completion working collaboratively with the needed interdisciplinary departments.

+ Participates in meetings, including feedback on outstanding issues, presentations for educational opportunities and any other needs identified by the CDI group.

+ Assumes personal responsibility for professional growth, development and continuing education to maintain a high level of proficiency.

+ Performs other duties as assigned.

+ Travels to different facilities of Advent Health on routine basis which could include overnight stay. Travel could be 30% of the time averaged over a calendar year.

The expertise and experiences you’ll need to succeed:

• Minimum of five (5) years acute care nursing experience with specific medical/surgical, Intensive Care, post-acute care unit, or Emergency Department experience.

• Two (2) years of Clinical Documentation Specialist experience

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

• Current active State license as a Registered Nurse, Nurse Practitioner, or Physician’s Assistant

• Unlicensed physician who has graduated from a medical school that is listed in the World Directory of Medical Schools (World Directory) as meeting eligibility requirements for its graduates to apply to the Educational Commission for Foreign Medical Graduates (ECFMG) for ECFMG Certification and examination at the time of graduation.

• CCDS (Certified Clinical Documentation Specialist) certification

• CDIP (Certified Documentation Improvement Practitioner) certification

Preferred Qualifications:

• Bachelor's Degree BSN

• Master's Degree MSN

**_·_** PROSCI Certification

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

**Category:** Health Information Management

**Organization:** AdventHealth Corporate

**Schedule:** Full-time

**Shift:** 1 - Day

**Req ID:** 25008959

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.