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Director, CDI & DRG Downgrade Appeals

Brentwood, Tennessee

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Success within a company doesn’t just happen. It requires committed teams of talented people who understand and embrace an organization’s goals and work together at the highest level to achieve them. As a member of the Health Support Center (HSC) team, you’ll work collaboratively with a great group of people to serve Lifepoint’s diversified healthcare delivery network of hospitals and care sites across the nation. We know that providing high-quality care depends on our ability to find, keep and empower creative and determined people who share in our commitment to our mission: Making communities healthier.

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Success Profile

What do you need to be successful at Lifepoint Health? Here are the top traits we’re looking for:

  • Analytical
  • Compassionate
  • Problem-solver
  • Collaborative
  • Goal-oriented
  • Thoughtful

“I have been with Lifepoint for 3 years and have been fortunate to grow within this great company. I feel valued, I work with amazing colleagues, and I enjoy coming to work every day!”

MikeManager, HITS Information Security
mike

Benefits

  • Competitive pay

    We offer competitive pay for all employees based on the market, role, skill set and experience.

  • Growth opportunities and succession planning

    Our succession planning initiatives identify an internal bench of top talent and offer development opportunities to prepare them to fill crucial roles in the organization as they become available.

  • Insurance (for eligible employees)

    We’re committed to you and your family feeling supported and secure – our benefits include medical, eye, prescription, life insurance, and more.

  • Collaborative work environment

    We know that providing high-quality care depends on our ability to find, keep and empower creative and determined people who work together to advance our mission – making communities healthier.

  • Paid time off (for eligible employees)

    At Lifepoint, we believe in a strong work-life balance and offer competitive paid time off.

  • Employee Assistance Program (EAP)

    As a Lifepoint employee, you and your family will have access to counseling and relationship support, legal services, financial services and more.

Director, CDI & DRG Downgrade Appeals

Brentwood, Tennessee

Job ID 302499 Date posted 05/16/2025
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Who we are:

At Lifepoint Health, we provide quality healthcare to rural communities. As a valued member of our team, you will be an integral part of a group working together to elevate Lifepoint's healthcare delivery network.Our network includes 60+ community hospitals, 60+ rehabilitation/behavioral health hospitals, and 250 additional sites of care across the United States.As an organization, we are dedicated to serving communities nationwide by providing exceptional care. We believe in the power of our talented teams and strive to create environments where employees find purpose and fulfillment.

What you’ll do:

As a Director, CDI, you will beresponsible for directing the activities of the CDI & DRG Downgrade Appeals Department and providing CDI program oversight and day-to-day implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record and oversight and the management of the DRG Downgrade appeals team. This includes, but is not limited to, overall responsibility for the planning, administration, control, and quality management of CDI and DRG Downgrade Appeals Department activities in addition to regular reporting of department progress and initiatives to HSC leadership. 

This position collaborates with providers and other healthcare team members to make improvements that result in accurate, comprehensive documentation that reflects completely, the clinical treatment, decisions, and diagnoses for the patient.  This position utilizes clinical expertise and clinical documentation improvement practices and facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Lifepoint. 

Responsibilities: 

  • Responsible for the operations, business, financial, and human resource needs of the CDI and DRG Downgrade Appeals Department.
  • Plan daily operations of the department in conjunction with the AVP of HIM Operations and participates in development of objectives to meet KPI’s.
  • Direct and maintains adequate staffing and workflow to meet CDI and DRG Downgrade Appeals department needs.
  • Lead the CDI program as demonstrated by assuming accountability for the ongoing success of the Clinical Documentation Program. Monitors CDI program and communicates with appropriate facility leadership regarding CDI key performance indicators (KPIs), and identifies and implements process changes to maintain and improve KPIs
  • Leads the DRG Downgrade Appeal department in responding to DRG downgrades and has processes to assure appropriate action is taken within the appeal time frame for initial and subsequent appeals.  Proactively reviews and creates new appeal templates for use by the team.
  • Collaborates with other departments/resources/entities as applicable to ensure the most optimal appeal outcome.
  • On a monthly basis presents identified denial trends and patterns to create education on root cases and preventable measures.
  • Utilizes appropriate applications to accurately track clinical denial data; participates in the development and implementation of a system-wide process for appeals.
  • Engage and consult with Physician Advisor and/or CMO to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process.
  • Serves as a resource to Physicians / Case Managers and other key professional staff in matters relating to clinical documentation improvement.
  • Develop and manage direct reports; and oversee the development and management of indirect reports. 
  • Plan daily operations of the department in conjunction with the AVP of HIM Operations and participates in development of objectives to meet KPI’s. 
  • Direct and maintain adequate staffing and workflow to meet the department needs. Monitor various reports and productivity to ensure department objectives are met. 
  • Interview, hire, provide leadership, counseling, training for employees in areas of responsibility.  Ensure new employees are oriented and trained in all job functions. Perform counseling both verbal and written for employees requiring additional assistance as evidenced by communication in the personnel file. 
  • Serve as a resource regarding policies/procedures/practices and identify areas of improvement/education through data collection, analysis, and reports. 
  • Communicate with hospital Health Information Management (HIM) and Clinical Documentation Improvement (CDI) regarding hospital specific CDI and DRG Downgrade opportunities.
  • Review proposed, concurrent, and retrospective physician queries to include but not limited to, formatting, process, responses, education, and tracking, to ensure all are compliant with AHIMA Standards of Ethical Coding and ACDIS Code of Ethics and Lifepoint Health policies and procedures.
  • Undertake continuous education courses to maintain knowledge base, auditing, and management skills consistent with the organization's and department's professional development requirements and individual credentials.
  • Maintain regular and reliable attendance.
  • Perform other duties as assigned.

What you’ll need:

  • Education: Associate degree or any equivalent combination of education, experience, and training that provides the required knowledge, skills, and abilities; Bachelor’s Degree preferred.
  • Experience: Minimum 5 years’ CDI and 3 years of DRG Downgrade appeals experience. 

Why choose us:

As a team member of the Health Support Center, our goal is to support those that are in our facilities who are interfacing and providing care to our patients and community members. Our focus is to attract, retain, and empower a diverse and determined workforce. Our mission statement is at the heart of who we are and what we do: “Making Communities Healthier.” In this shared mission, we believe that our collective efforts will shape a healthier future for the communities we serve.

Benefits:We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

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