CDI Physician Advisor (multiple)

Come join our Northern California team, as we expand our scope into CDI.  Several hybrid positions now available, including in the Central Valley (Modesto) region, and wine country (Sonoma/Lake/Marin)
Position Overview:
The Physician Advisor (PA) is a key member of the hospital's leadership team
charged with meeting the organization's goals and objectives for ensuring the
effective, efficient utilization of health care services. The PA will develop

expertise on matters regarding physician practice patterns, over- and under-
utilization of resources, medical necessity, documentation best practices, level

of care progression, denial management and compliance with governmental
regulations and conditions of participation and commercial insurance contracts.

SKILLS AND KNOWLEDGE:
Quality Management & Performance Improvement:
• Effectively leads change in behavior on the documentation needs of the medical staff and other clinical
providers to achieve organizational objectives related to quality improvement and revenue cycle initiatives
• Assists with the creation and implementation of documentation strategies for accurate and complete
reflection of the quality of care
• Applies knowledge of coding rules and regulations, along with understanding of risk adjustment and
quality reporting methodology to achieve organizational goals
• Elicits optimal value from documentation as a marker of quality of care

Operations:
• Reviews cases escalated by CDI team for potential documentation opportunities
• Participates in unanswered query escalation process by following up with physicians electronically and
in-person to obtain query responses
• Meets regularly with CDI Director, CDI Managers, and CDI Leads to understand current areas of
opportunity and discuss unanswered queries
• Provides clinical feedback and provider perspective to CDI team to build credibility of the program and
CDI staff
• Partners in the development, coordination and presentation of provider education:
Focused on improving the accuracy of documentation and the reflection of the quality of
patient care reported, expected mortality, expected length of stay, medical necessity and
other documentation related outcomes.
•

Shares key clinical documentation concepts and their importance for hospital and individual
providers
•
• Tailors education content and messaging to specific provider groups and specialties
• Collaborates with subspecialty providers to create consistent definitions and documentation around
complex conditions
• Develops and participates in recognition process for providers that have made significant positive
impacts to the program
• Helps to develop clinically appropriate and compliant provider queries to clarify documentation
• Evaluates current documentation systems, tools and processes and recommends innovative initiatives
and improvements
• Provides guidance and coaching to providers on how to use updated functionality effectively
• Leads multidisciplinary and multi-departmental provider engagement strategies related to CDI strategic
goals and objectives
• Involved in Clinical Documentation Integrity Steering Committee and Quality Committees, as appropriate

Communication:
• Serves as liaison for providers and CDI team to address issues and questions
• Proactively manages each group’s perspectives and facilitates a collaborative relationship among
stakeholders
• Holds one-on-one meetings with physicians to address areas of opportunity and respond to questions
• Identifies preferred methods of communication for individual providers and/or provider groups
Quality, Financial and Data Management:
• Regularly reviews key process and outcomes metrics related to the CDI program:
Process metrics: provider response rates, agree rates, response times, query trends,
among others
•
Outcomes metrics: medical and surgical capture rates, capture rates by service line,
capture rates by DRG triplets and pairs, case mix index, expected mortality, observed to
expected mortality ratio, CMS Star ranking, Vizient rankings and risk variable capture,
Leapfrog rating, among others

• Develops action plans for non-responsive providers, providers with high disagreement, and service lines
with risk variable capture opportunity
• Reports performance data and significant issues to senior leadership