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Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials is responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, policies and procedures related to clinical documentation improvement for all Garnet Health hospitals. The Manager is responsible for leading CDI functions and overseeing the day to day work in the department. The Manager ensures that reviews of the patient’s medical data are conducted to assess appropriateness and medical necessity for admission, and continued stay. The Manager facilitates improvement in the overall quality, completeness, and accuracy of medical record documentation. The Manager will evaluate denials and work closely with the outcomes manager and coding denial coordinator to oversee and write compelling, factual arguments when warranted to the third-parties denying claim.

Join the Garnet Health team and let your excellence shine.

Minimum Education:

• Bachelor's Degree in Nursing

Minimum Experience:

• Minimum of 3-5 years of progressive experience in an acute care hospital (larger than 100 beds)
• Minimum of five years of experience in the CDI industry
• Strong knowledge of ICD 10 diagnosis coding, CPT Coding guidelines and DRG-based reimbursement knowledge, required
• Exceptional ability to communicate effectively with physicians and other clinical professional staff.
• Knowledge of DRG and Coding appeal process

Required Certification/Registration:

• Certified Clinical Documentation Specialist (CCDS) credentialed within 6 months
• Current license to practice as a Registered Professional Nurse in New York State required.

Physical Requirements: Travel to multiple facilities is required.

Working Conditions:

• Environmental Demands and Exposure to Hazards: Works in a clean, well- lighted, heated or ventilated facility. No routine exposure to hazards.
• Physical Demands: Demonstrates physical and functional ability to perform full anatomical range of motion to accomplish tasks. Evidence of visual and aural acuity and finger and hand dexterity to operate computer and office equipment. Can withstand long periods of sitting, standing and/or constant walking. Ability to lift 10 lbs.
• Mental Demands: Ability to foster collaborative relationships, to work well under pressure, to organize and synthesize new information, and prioritize tasks. Possesses critical thinking, analytical skills and flexibility. Ability to multi-task. Required detailed attention to work in an environment where interruptions cannot be controlled. Demonstrates sensitivity to customer needs and expectations. May be subject to irregular hours including evenings or potentially weekends to participate in operational and community events as necessary.