Inova Health

• The Case Management Specialist coordinates and performs administrative activities to support the Case Management department. • Participates in the annual and ongoing budget processes. • Arranges services for assigned patient populations including Home Health, Durable Medical Equipment, Ambulance, Housing, Skilled Nursing Facility and others in order to ensure that appropriate continuing care services are in place for patient transitions. • Communicates and documents accurate clinical/financial information in both verbal and written forms. • Delivers and documents delivery of regulatory forms such as the mandated Observation letter, and the Medicare IMM notifications. • Conducts timely arrangements of services to meet customer requirements. • Addresses and solves provider and payor issues quickly with support from Case Management staff. • Tracks and monitors accounting for budgets, capital requests, travel funds and business expenses.

• Collects delay and other data for specific performance and/or outcome indicators. Assists in the collection and reporting of resource and financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g. discharge planning, chronic disease planning). • Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently. Ensures safe care to patients by adhering to policies, procedures and standards within budgetary specifications including time management, supply management, productivity and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency. Supports department based goals which contribute to the success of the organization. • Provides discharge planning and continuity of care for assigned patients in the acute and post-acute setting. Initiates and facilitates referrals to clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated. Collaborates with the interdisciplinary healthcare team, patients and families in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs, delivery of post-discharge services and transition of patients from hospitals to the discharge setting as well as ongoing care in the community. Documents relevant discharge planning information in medical records according to department standards and/or care management plans. • Collaborates/communicates with internal and external case managers. Understands pre-acute and post-acute resources. Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members. Work closely with members of patients' healthcare teams to manage and coordinate all areas of patients' care. Works holistically to ensure that healthcare plans and discharge plans meet the physical, social and emotional needs of patients.

• Implements and maintains EpicCare systems and databases to ensure optimum performance. Performs analysis of new releases and determines how they will impact workflow. • Defines modifications to application software or databases to address system functions or enhancements. • Facilitates Epic updates, new releases and system enhancements. Manages all phases of testing and assists Lead/Project Manager in work effort and project scoping. • Manages complex IT projects/products in order to provide automated solutions that meet Inova Health System's business needs using the EpicCare solution. • Initiates issues for resolution while escalating and communicating status to management in a timely manner. • Conducts and participates in system technical and application reviews to determine feasibility, cost and evaluate usefulness for Inova. Coordinates vendor demos, site visits and reference calls. • Makes recommendations for team/analyst training programs and assists in the development and implementation of team member training/mentoring activities.

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Serves in the place of the supervisor or manager in their absence. • Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks assistance from supervisor when needed. • Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity. • Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs. • Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt. • Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards. • Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures. • Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager. • May perform additional duties as assigned.

• Meets coding productivity standards as established by the Coding Operations Director and Coding manager. • Ensures the accurate and complete assignment of Evaluation and Management, CPT, and ICD-10 CM codes that are supported by medical record documentation found in Outpatient Ancillary and Emergency Department encounters. • May perform additional duties as assigned.

• Provide analytic support to internal leaders and external community organizations. • Collaborate with stakeholders to gather and translate technical requirements into scalable BI solutions. • Capture and consolidate source data with proper data lineage and change control. • Perform data modeling and ensure deliverables follow standard definitions and policies. • Determine logical design characteristics and information management strategies. • Create, vet, and publish data sources for common use in BI tools (e.g., Epic, PowerBI). • Develop and maintain community programs using Epic, PowerBI, Excel, and other tools. • Generate impactful, interactive visualizations with consistent data elements. • Ensure data integrity and proper definitions through continuous review of dashboards.

• Implements and maintains EpicCare systems and databases to ensure optimum performance. • Performs analysis of new releases and determines how they will impact workflow. • Defines modifications to application software or databases to address system functions or enhancements. • Facilitates Epic updates, new releases and system enhancements. • Manages complex IT projects/products in order to provide automated solutions that meet Inova Health System's business needs using the EpicCare solution. • Initiates issues for resolution while escalating and communicating status to management in a timely manner. • Conducts and participates in system technical and application reviews to determine feasibility, cost and evaluate usefulness for Inova. • Coordinates vendor demos, site visits and reference calls. • Makes recommendations for team/analyst training programs and assists in the development and implementation of team member training/mentoring activities. • Performs other duties as assigned.

• Oversees department to ensure it is performing effectively, which may include but not limited to, hiring and training team members, creating and implementing business strategies, managing performance of team members, and delegating tasks. • Ensures technical accuracy and presents project plans to management for review and approval. • Provides effective applicant behavioral interviews and makes hiring recommendations to the applications leadership. • Ensures Applications team develops, demonstrates and maintains proficient use of project management software and tools. • Provides staff orientations, coaching, mentoring and training as necessary. Works closely with leadership providing input on staff performance. • Ensures Applications team understands and adheres to project implementation and problem resolution priorities set forth by Epic standards and Information Technology (IT) department policies. Collaborates with IT and purchasing resources on recommendations for purchase. • Ensures that the Applications team communicates and follows up in a positive and meaningful manner with other Applications teams, IT management and end-users on the status of problems, current tasks and project priorities. • Provides analysis on progress against plan and results against goals. • Leads and assists Applications team in developing logical, detail-oriented project plans to include tasks, implementation time frames, resource allocations and possible cost estimates and cost/benefit analysis.

• Performs initial case reviews and an appropriate number of follow-up reviews based on program standards. Uses clinical insight and judgment of clinical findings to assess clinical documentation for improvement opportunities. Independently develops complex queries. • Maintains query rate, response rate, and agreement rate in line with established performance benchmarks. • Assists with reviewing records at different Inova hospitals as needed and under the supervision of assigned CDI leaders. • Participates in all department-wide CDI and coding education on ICD-10, MS-DRG, and quality outcome measures as well as compliance requirements related to query (AHIMA Practice brief). • Maintains competency in the use of CDI applications to process daily work lists and report results of record reviews and queries. • Enters all required data into CDI applications to enable Coding professionals and Coding Quality Coordinators to determine the disposition of concurrent queries in order to assign the final MS-DRG as well as APR-DRG, SOI, and ROM and risk adjustment factors. • Demonstrates expert knowledge of ICD 10 codes and MS-DRG/APR DRG assignments. • Interacts with Coding Quality Coordinators and Coding professionals on any questions related to CDI working DRG related to concurrent queries and final coding. • Assists with any post-discharge (retrospective) queries per CDI policy/procedure and as requested by CDI leadership. • Demonstrates advanced technical ability with current software used by the department. • Provides electronic support to providers regarding best practice documentation standards and the query process. Provides 1:1 provider education within the daily workflow and participates in group education sessions as requested by CDI Leadership. • Participates in special projects, audits, and other duties as directed by CDI Leadership. May assist with precepting and education of new staff. • Works collaboratively with medical, nursing, and ancillary staff to improve the quality of chart documentation that assures appropriate DRG classification to accurately reflect patient severity of illness and risk of mortality. • Participates, and takes a leadership role in, select special projects, audits, and other duties as directed by CDI Leadership. • As needed, may travel across the Washington DC metro area to engage with providers. • May perform additional duties as assigned.

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Serves in the place of the supervisor or manager in their absence. • Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks assistance from supervisor when needed. • Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity. • Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs. • Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt. • Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards. • Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures. • Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager. • May perform additional duties as assigned.