COMPLIANCE AUDITOR-CLINICAL DOCUMENTATION in Chicago, Illinois at Sinai Chicago

Position Purpose:

The Compliance Auditor of Clinical Documentation Integrity at Sinai Chicago serves as a clinical consultant and subject-matter expert for engagements with the clinicians and Patient Access staff. The role focuses on provider engagement and education in clinical documentation integrity and ensuring RCM Cash Collections are met monthly through performing direct audits and correcting inefficiencies daily based on RCM benchmark KPI’s. Additional clinical revenue cycle projects may focus on Patient Access authorization denial management, coding optimization, CDI, HIM, organizational structure redesign, optimization, and centralization. Project efforts may require collaboration with key teams typically outside the revenue cycle, such as care management, utilization review, quality assurance, population health, and other key areas as needed and as directed by the Chief Revenue Officer to prevent uncompensated care. The role is responsible for the overall Patient Access Financial and Clinical transformational performance of the remote and onsite CDI Specialist and Patient Access Management Staff. Functions include, but are not limited to, performance and process improvement, data trending and analytics to drive decision-making, critical thinking to get to root cause, collaborating with departments across the organization to course correct, develop and monitor data driven key performance indicators to measure progress.

Reports to: Chief Revenue Officer/Director of CDI

Supervises: CDI Specialist, RCM Patient Access Managers

Key Job Activities:

• Develops strategies, oversees, and coordinates the execution of Revenue Cycle projects by collaborating with the leadership of key areas including, but not limited to Accounts Receivable, Financial Clearance, HIM/Coding/Revenue Integrity, Patient Access, CDI, and Clinical Operations.
• Responsible for the development and execution of CDI and PFS quality and process improvement plans that identify root causes with proactive and sound approaches.
• Identifies and communicates issues for escalation. Collaborates with Revenue Cycle partners to identify and systematically resolve patterns, workflows, and processes.
• Creates and consolidates structures with monitoring. Develops a methodology and committee structure to manage the performance of Revenue Cycle functions and govern operational changes that may be necessary to prevent future loss in key areas including but not limited to Accounts Receivable, Financial Clearance, HIM/Coding/Revenue Integrity, Patient Access, CDI, and Operations.

• Education and Work Experience:

• Master’s degree preferred; LPN/RN/Medical Doctor preferred
• In lieu of a degree, a minimum of 12 years’ experience in Patient Accounts, Patient Access and CDI required within a healthcare setting will be considered.
• Experience facilitating the formal exchange and delivery of information within all levels in a provider's and executive leaders
• Exceptional subject matter knowledge of acute care and professional billing clinical documentation
• Willingness and ability to learn and expand clinical knowledge and PFS knowledge to ensure ongoing career and organizational efficiency stays current

Certifications/Licenses:

• Certified Clinical Documentation Specialist (CCDS) credential l - Required
• Coding certification: CIC, CCS, CMS, RHIA or RHIT - Required
• Billing and or Patient Accounts Certification (Epic Resolute, Billing Certificate) - Preferred