Director Clinical Documentation Integrity (CDI) and Coding

SHIFT:

Seeking Breakthrough Makers

Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP's Commitment to Diversity, Equity, and Inclusion

CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.

We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

A Brief Overview

The Director of Clinical Documentation Integrity (CDI) and Coding is responsible for the direction of the operational, financial, programmatic, and personnel activities of Children's Hospital of Philadelphia Clinical Documentation Integrity and Coding programs. The Director ensures that the departmental mission is well defined and communicated to staff, that the key service goals and objectives are set and plans to attain them are established and followed in each of the sections. This individual represents the department in planning efforts involving space, equipment staff, systems, services, expenses, cost monitoring and control, operational monitoring, regulatory compliance, and future programs and services. The Director works closely with a variety of clinical and non-clinical stakeholders, coordinating the activities of Clinical Documentation Integrity and Coding across the system.

The Director for Clinical Documentation Integrity and Coding is responsible for a diverse, growing department requiring skills in data-driven decision-making, project and portfolio management, system redesign, process improvement/lean management, and customer relationship management. The position requires a deep knowledge of industry best practices in technology and workflow. The Director will use these skills and experience to partner with stakeholders to develop an organization-level roadmap of process and technology improvements to reduce provider burden and maximize patient experience while increasing efficiency. This position is responsible for the strategic direction of Clinical Documentation Integrity and Coding across the health system centered on improved accuracy and efficiency.

The range of duties for this position are broad, varied, and will change over time, the responsibility is directing the day-to-day operations in a manner that supports compliance with Pennsylvania laws and Administrative Code, CMS Medicare Conditions of Participation, AHA Official Coding Guidelines, HIPAA regulations, The Joint Commission, Federal Rules of Civil Procedure, budgeting, financial management and human resource management of Children's Hospital of Philadelphia Clinical Documentation Integrity and Coding programs.

This position also has a broad understanding of all areas of the revenue cycle; including but not limited to Patient Financial Services (PFS), Health Information Management (HIM), Revenue Integrity (RI), and Reimbursement Services.

This role will report to the Associate Vice President of Revenue Integrity and Health Information Management.

What you will do

1) Departmental Leader

• Provides an experience and environment of patient-and family-centered care.
• Interprets impact of broad scope organizational change for staff and develops change strategies for successful implementation.
• Models ICARE values through all interactions.
• Leverages leadership competencies to develop themselves and others.
• Develops and manages operational initiatives with measurable outcomes.
• Formulates objectives, goals, and strategies collaboratively with other stakeholders.
• Prepares and delivers reports to operational leadership outlining progress toward meeting quarterly/annual goals and objectives, to include performance related to finance, clinical activity, quality, and human resources.

2) Financial Manager

• Actively seeks opportunities to improve financial outcomes, engaging staff in the process.
• Establishes annual financial goals and actively uses benchmarking to high performing systems in similar area of expertise to set quarterly/annual targets.
• Monitors and analyzes financial data and utilizes decisions regarding FTE's. staffing, and operational budget.
• Establishes an annual operating and capital budget, demonstrating fiscal responsibility through meeting budget targets.
• Creates business plan(s), justifying variances and analyzing cost benefit of programs.
• Directs and provides guidance to managers to effectively allocate resources based on patient volume, space availability, budget constraints, and program priorities, goals, and objectives.
• Articulates to staff the budget and the context within the organizational financials.

3) Administrative Leader

• Contribute to the success of Children's Hospital of Philadelphia by providing leadership, direction, and coordination of operations, finances, and human resources for area of responsibility.
• Manage and direct all activities within area or responsibility.
• Continually assesses all services, identifies problems, utilizes data to analyze and propose innovative approaches for solutions.
• Maintain records related to operations and services that are complete, accurate, available, and in compliance with all legal, regulatory, and policy requirements.
• Engages staff and other stakeholders in continuous improvement of systems and processes; manages resources for staff participation in improvement work activities.
• Ensures effective facilitation of improvement teams and development of leadership skills to ensure overall effectiveness of the meetings.
• Organizes and prioritizes time and resources to manage efficiency. Appropriately delegates.
• Remains current of new trends and best practices and incorporates into Clinical Documentation Integrity and Coding practices and programs.
• Articulates and enforces standards for quality and productivity.
• Develops and implements innovative systems and processes that improve staff, quality metrics and outcome measures.
• Demonstrates achievable and measurable results and develop action plans for improvement.
• Initiates, monitors, and enforces regulatory requirements.
• Holds self and others accountable to policy, standards, and commitments and provides timely follow through on questions and concerns.
• Ensures development of Clinical Documentation Integrity and Coding initiatives to improve patient satisfaction and family centered care.
• Develops and implements clinical outcome measures for quality improvement.
• Incorporates the use of evidence-based practice and appreciative inquiry into program development and improvement activities.
• Actively listens to staff ideas and concerns, assesses others communication styles ad adapts to them.
• Effectively facilitates meeting with Clinical Documentation Integrity, Coding, Revenue Integrity, and Revenue Cycle Operations and organizational level.
• Creates bi-directional systems that effectively communicate information and data, utilizing multiple methods.
• Articulates and presents data, information, and ideas in a clear and concise manner.
• Communicates opinions and ideas in a nonthreatening and nonjudgmental manner to staff, peers, and others.
• Communicates with physicians, academics department leaders, and senior administrators to maintain coordination with other Children's Hospital of Philadelphia programs.
• Demonstrates empathy and concern while ensuring goals are met.
• Manages the complex interdepartmental and interdisciplinary relationships to assure collaboration and effective/efficient operations within Clinical Documentation Integrity, Coding, Health Information Operations, Revenue Integrity, and revenue Cycle.
• Creates an environment that encourages diverse opinion, recognizes differences, and incorporates into processes and services.
• Exhibits awareness of personal attitudes and beliefs, recognizing its effect on response to others.
• Creates a culture and systems for recognizing and rewarding staff.

4) Resource Manager

• Creates and maintains a satisfying workplace that fosters professional growth and job satisfaction for all members of the healthcare team.
• Interviews to select top talent, matching Clinical Documentation Integrity and Coding needs with appropriate skills.
• Develops and implements recruitment and retention strategies that support culture of leadership.
• Identifies and addresses own professional growth needs.
• Assesses manager and staff development needs, identifies goals and provides resources.
• Identifies lack of competency in performance and establishes a plan which includes goals, interventions, and measures.
• Maintains membership in professional organization(s) to develop knowledge and resources through networking, continuing education, and participation in national, regional, and/or local activities.
• Ensures integration of ethical standards and core values into everyday work activities.

5) Educator/Research Facilitator

• Provides opportunities to leaders and staff to develop skills to meet career goals.
• Contributes to a learning environment by providing educational opportunities to staff, cross-functional departments, students, residents, fellows, and faculty.

6) Critical Interfaces

• Leads and /or serves on a variety of appropriate internal and external committees to represent Clinical Documentation Integrity and Coding programs.
• Serves as a representative to Children's Hospital of Philadelphia to facilitate the shared interests and relationship between cross-functional teams.

7) Compliance, Performance Metrics and Controls

• Manage and meet quality and production targets related to Clinical Documentation Integrity and Coding.
• Develop and maintain KPI/SLA/performance metrics and reports to ensure optimal performance and responsiveness to internal and external stakeholders.
• Prepare pertinent weekly and monthly department metrics and status relating to the performance of Clinical Documentation Integrity and Coding.
• Develop and implement Clinical Documentation Integrity and Coding policies and procedures, including medical terminology, audit, and related compliance processes. Monitor staff compliance with policies and procedures to ensure quality outcomes for the company.
• Ensure that all coding and auditing practices meet CMS guidelines and compliance policies of Children's Hospital of Philadelphia.
• Maintain an objective quality program that ensures compliance with CMS, ICD-10, and CPT coding requirements.
• Document quality assurance issues and communicate these issues to the appropriate department(s).
• Identify opportunities for improvement in physician documentation and facilitate implementing such improvements cross-functionally.
• Interpret, provide feedback, and act as a subject matter expert of CMS regulations related to CDI, coding, and auditing process and guidelines in a timely and knowledgeable manner.
• Effectively use financial information for strategic and operational decision-making, participate in preparing annual budgets, monitor financial performance, and meet agreed-upon metrics.
• Manage outsourced vendors, including service level agreements (SLA).
• Communicates significant audit findings to appropriate Department Manager and Senior Finance Partner within 2 weeks of audit completion so corrective actions will be taken as needed.

8) Maintains knowledge of clinical care, billing, coding compliance rules and other pertinent regulations completes required minimum amount of continuous education units to maintain all required certifications.

9) Prepares formal reports and makes formal presentations on revenue cycle assessment findings on a regular basis

• Recipients may include clinical staff and department managers, members of Administration, PARC staff, etc.
• Demonstrates excellent verbal communication skills.
• Demonstrates excellent written communication skills.
• Demonstrates expert use of applications such as Word, Excel, and PowerPoint in written reports.

10) Assists with other projects as necessary

• Supports Revenue Analytics Team with month end close.
• Contributes to Revenue Analytics providing clinical care and billing guidance for contract negotiations.
• Collaborates with Internal Audit and Billing Compliance Departments on clinical department reviews and remediation of any issues.
• Collaborates with PFS and HIM Operations to help resolve Billing and/or Collection issues.

Education Qualifications

• Bachelor's Degree Health-related field required

Experience Qualifications

• At least five (5) years management experience in medical coding, clinical documentation integrity in a medium or large healthcare facility.

  required

• At least three (3) years experience with an academic medical center preferred

• At least six (6) months experience with pediatrics services preferred

Skills and Abilities

• Demonstrated creativity and flexibility. Required

• Ability to operate in high-pressure situations. Required

• Working knowledge of revenue cycle processes. Required

• Demonstrated innovative approach to problem resolution. Required

• Ability to work collaboratively across Children's Hospital of Philadelphia entities and disciplines. Required

• Broad knowledge of modern health care administration practices and principles within a managed care environment and/or an academic medical center. Required

• Effective and analytical ability to develop and analyze options, recommend solutions to and solve complex problems and issues. Required

• Demonstrated effective managerial and administrative leadership of coding operations and collaborative working with Clinical Documentation Integrity programs. Required Knowledge of principles and techniques used in negotiation as applied to service contracts and equipment purchasing. Required

• Effective organizational, planning, and project management abilities. Required

• Experience in financial and programmatic presentations. Required

• Ability to function independently and deal with multiple, simultaneous projects. Required

• Ability to recognize personal strengths and weaknesses and develop goals for professional growth and achievement. Required

• Ability to demonstrate a commitment to quality and excellence. Required

• Effective leadership abilities:

  - Ability to implement change in a positive, sensitive, and forward-thinking manner; planning and problem solving; developing goals and objectives, and establishes priorities; inspires confidence, appropriate risk taking, and achievement of high standards; self-started with a willingness to try new ideas; positive, can-do attitude coupled with a sense of urgency; good judgement and ability to act decisively at the right time; ability to persuade others to act decisively at the right time; ability to persuade others and develop consensus; effective communication skills both in written and verbal presentation with a communication style that is open and foster trust, credibility, and understanding; ability to effect collaboration and promote teamwork; ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians, and external stakeholders; ability to create win/win solutions and relationships. Required

• Expert knowledge of coding rules. Required

• Computer skills essential. Required

• Will need to use Word, Excel, PowerPoint, and Visio at a minimum. Required

Licenses and Certifications

• Certified Coding Specialist (CCS), American Health Information Management Association (AHIMA) upon hire required and

• Registered Health Information Administrator (RHIA), American Health Information Management Association (AHIMA) upon hire required and

• Certified Revenue Cycle Representative (CRCR), Healthcare Financial Management Association (HFMA) within 12 months required

• Certified Clinical Documentation Specialist (CCDS), Association of Clinical Documentation Integrity Specialists (ACDIS) upon hire preferred

• Clinical Documentation Improvement Practitioner (CDIP), American Health Information Management Association (AHIMA) upon hire preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.

Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.

EEO / VEVRAA Federal Contractor | Tobacco Statement