The CDI Physician Advisor provides clinical oversight of all documentation needs including, but not limited to ICD-10 system-specific diagnostic terminology, appropriate disease process recognition, compliance security, quality improvement, and Medicare Severity (MS)-DRG validation denial reduction strategies. Directs effective changes in behavior and practice patterns of medical staff and other clinical providers to achieve accurate severity of illness descriptions within the medical record. The Physician Advisor provides education to all practitioners on: correct MS-DRG assignment, and current ICD-10 system coding guidelines.
Provides leadership and direction for any necessary behavior change and practice patterns of medical staff and other clinical providers to achieve accurate severity of illness descriptions within the medical record.
Collaborates efforts with the performance improvement department for accurate determination of APR-DRG based risk of mortality assessments as well as assisting in the development and implementation of provider quality metric improvement strategies.
Provides advice to practitioners, CDIS, RNs and HIM, coders on clinical documentation and coding issues pertaining to publicly reported performance data, accurate complication assessments, medical necessity assurance, length-of-stay management, and recovery auditor practices.
Prepares reports that highlight practitioner, group, and service line documentation patterns.
Develops and implements strategy for corrective action plans to address performance deviations from benchmarked expectations.
Leads clinical documentation improvement efforts, ensuring accurate and clinically sound information.
Collaborates effectively with all medical specialties and is comfortable conversing with the various medical and surgical specialties throughout the health system.
Provides data analysis of trends in the case mix index of medical and surgical cases, risk adjustments, PSI audits, HACs, etc.
Provides physician oversight for both the inpatient and outpatient CDI teams and coordinates documentation improvement activities with other committees.
Identifies patterns of documentation that conflict with the stated goals of CDI initiatives as well as the formulation and implementation of corrective educational interventions as appropriate.
Acts as expert clinical consultant to coding, performance documentation improvement, compliance oversight, utilization review, denials management, and the revenue cycle.
Assists in achievement of clinical performance goals, including reductions in hospital-acquired conditions and improved patient safety indicator performance.
Brings matters of potential or actual problems in practitioner documentation practices and/or medical record coding to the attention of health administration leadership.
Consults with physicians in areas outside own expertise to bring specialty knowledge to bear on complex clinical documentation patterns and medical record coding accuracy.
Maintains communication network and collaborative relationship with the medical staff, CDI, and HIM.
Actively serves on or leads medical staff committees and health system committees as deemed appropriate.
Proactively integrates and promotes principles of continuous quality improvement to raise the standard of practitioner documentation patterns and medical record coding accuracy.
Collaborate as necessary with TMCH Information Systems on documentation related improvements to Provider software templates and charting flow.
Adheres to TMCH organizational and department-specific safety, confidentiality, values, policies and standards.
Performs related duties as assigned.
EDUCATION: MD/DO unrestricted license to practice in the state of Arizona or the ability to obtain an unrestricted medical license to practice in Arizona. Graduate of an accredited medical program; MD or DO degree required plus three (3) years of postgraduate training in addition to current board certification in a recognized clinical discipline.
EXPERIENCE: Five to ten (5-10) years of direct clinical practice. Knowledge of information technology, statistical analysis and reporting, electronic medical record documentation, clinical protocols, case management programs, and outcome measure assessments. Minimum of five (5) years’ experience as a medical director, or similar role in a healthcare system with experience in documentation optimization, coding education and denials management.
LICENSURE OR CERTIFICATION: Unrestricted AZ medical license. Unencumbered DEA for the state of AZ. Current Board Certification in a recognized clinical discipline.
KNOWLEDGE, SKILLS AND ABILITIES:
Ability to analyze, interpret, and prepare and present reports to management