BJC Healthcare COORD, CLIN DOC - QUALITY in Saint Louis, Missouri
Your Career. Made Better.
BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions.BJC serves patients and their families in urban, suburban and rural communities through its13 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
Perform post-discharge reviews prior to final coding and billing of target case populations across BJC. Respond to concurrent review requests from CDSs, provides guidance when CDSs and Coders cannot reconcile DRG mismatches, approve the withdrawal of queries by coders, and escalate unanswered queries to Physician Champions. Analyze data and reports to identify trends and areas of opportunity and provide education to facility-based CDSs and physicians based on this analysis.
Performs post-discharge, pre-bill reviews of target case populations (low acuity deaths, long length of stay focus areas, sign & symptom principal diagnoses, HACs/PSIs, etc.) to verify that all significant secondary conditions are accurately reported. When appropriate, queries physicians for additional documentation or specificity to ensure completeness and accuracy of the medical record
Performs concurrent chart reviews for complex cases and presents findings to physicians to demonstrate documentation opportunities and assist in future physician-led documentation initiatives.
Develops and promotes collaborative processes and strong working relationships with physicians and other health care professionals to accomplish program goals and ensure exceptional documentation. Key processes include:oValidate the appropriateness of coder requests to withdraw an outstanding query.oRespond to requests for clinical review and perspective on those cases when the CDS and coder cannot reconcile the final DRG.oAssist Coding Quality Coordinators (CQCs) with requests for review from a clinical perspective.oHelp facilitate query escalation to the Physician Champions (concurrently or post-discharge).
Analyzes regular reports and CDI metrics (e.g., Severity of Illness [SOI] and Risk of Mortality [ROM], Mortality Ratios, and CDS Coverage metrics) in conjunction with clinical examples found in the reviewed charts to 1) identify trends, 2) develop education plans for CDSs, coders, and physicians, and 3) provide facility-specific education based on these analyses
Regularly reviews changing compliance standards and guidelines and ensures CDSs are aware and following new standards. Collaborates with coding to ensure compliant practices, such as effective but non-leading queries.
- 2-5 years
Licenses & Certifications
- Master's Degree
- 5-10 years
Licenses & Certifications
Note: not all benefits apply to all openings
- Comprehensive medical, dental, life insurance, and disability plan options- Pension Plan/403(b) Plan- 401(k) plan with company match- Tuition Assistance- Health Care and Dependent Care Reimbursement Accounts-On-Site Fitness Center (depending on location)-Paid Time Off Program for vacation, holiday and sick time
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.
Equal Opportunity Employer