Data Quality Specialist (DAD/NACRS) - Decision Support

Position Overview

Reporting to the Manager Decision Support, Coding, Data Quality and Reporting, the Data Quality Specialist is responsible for auditing DAD and NACRS coded cases from a coding completeness and appropriate HIG/Case Mix Index (CMI) assignment perspective.  This individual supports the organization through the maintenance of processes related to clinical documentation guidelines, education, chart reviews with the clinical team, coding audits and implementation of quality control processes as required for DAD and NACRS data submission.  The Data Quality Specialist will also interface with various external information management entities, such as QBP Working Groups, Cancer Care Ontario and the Canadian Institute for Health Information and provide oversight to the DAD and NACRS coding team.

Summary of Major Responsibilities

• Operationalization of a clinical documentation improvement program to achieve the following
  1. Implement processes to clarify conflicting or nonspecific physician documentation
  2. Capture of comorbid conditions and high cost interventions that better reflect the complexity of the patient and Sunnybrook’s case mix index
  3. Build better relationship between clinicians and coders
  4. Improve coders clinical knowledge, improve efficiencies in coding and reduce turnaround times
  5. Improve data capture to reflect indicators and outcomes of quality of patient care
  6. Developing and operationalizing Sunnybrook Program/provider feedback (i.e. documentation requirements and education to clinical staff)

• Perform Quality Control processes and coding audits on DAD and NACRS coded data
• Developing and managing of audits required to address data quality gaps (coding and clinical documentation)
• Developing and operationalizing training programs and education materials to address consistency and standardization of collecting relevant clinical data
• Reporting of indicators related to HIG/CMI changes and reasons for change to the senior leadership team/Utilization Committee as a result of clinical documentation and coding audit findings
• Other related duties as assigned by Manager/Director

Qualifications/Skills

• Degree in Health Information Management (HIM)
• HIM certification and active member with the Canadian Health Information Management Association (CHIMA)
• 5 years’ experience in inpatient (DAD) coding, preferably within a tertiary or teaching facility. 
• Indepth knowledge and understanding of CMG's, HIG’s, ACW's, Case Mix Index (CMI), Quality Base Procedures (QBP’s) and expected length of stay
• Demonstrated coding competency in DAD and NACRS coding
• Excellent organization as well as strong written and verbal communication skills
• Excellent analytical and problem solving skills
• Adherence to confidentiality policy for sensitive clinical/patient information.
• Proficient in MS Office (Excel, PowerPoint, Word, Outlook)
• Demonstrated satisfactory performance and attendance record