Job Description
Role Description
We are recruiting for a motivated RN Specialist, Clinical Documentation to join our team!
Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director. Responsible for selected assignments based on internal or external department requests. Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary. Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record. Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies.
- Essential Functions:
- Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of provider documentation. (20%)
- Tracking audits performed and audit results obtained in order to provide meaningful data to key stakeholders. (20%)
- Educating providers regarding documentation accuracy, specificity, and compliance with rules and regulations. (20%)
- Providing pertinent feedback to providers on audit results as necessary. (20%)
- Working collaboratively with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services, and other departments to promote the common goal of obtaining accurate documentation in the patient record. (20%)
- Qualifications
- Associate's Degree Required
- 4-6 years of experience as a nurse in a hospital environment Required
- 3 of the 6 years with the appropriate level of experience in one or a combination of the following medical documentation related functions: clinical coding, case management, DRG coordination, physician education, Medicaid/Medicare reimbursement Required
- Requirements
- RN-Registered Nurse - DORA - Department of Regulatory Agencies Required
- Knowledge, Skills and Abilities
- Must be able to demonstrate knowledge of the pathophysiology of the disease process.
- Must be able to demonstrate clinical expertise in areas of urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care.
- Must be able to communicate and interact tactfully with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively.
- Ability to read and interpret professional journals, financial reports, and legal documents as necessary.
- Ability to define problems, collect and summarize data, establish facts and draw conclusions.
- Possesses knowledge of clinical documentation and coding concepts, DRG assignments, Inpatient Prospective Payment System (IPPS) and CMS rules and regulations.
- Must also be able to demonstrate knowledge including but not limited to, value-based purchasing, bundled payments, accountable care organizations and readmission reduction program.
- Microsoft Office Excel and SharePoint.
- Variety of documentation and coding programs.
- Benefits
- Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans.
- Free RTD EcoPass (public transportation).
- On-site employee fitness center and wellness classes.
- Childcare discount programs & exclusive perks on large brands, travel, and more.
- Tuition reimbursement & assistance.
- Education & development opportunities including career pathways and coaching.
- Professional clinical advancement program & shared governance.
- Public Service Loan Forgiveness (PSLF) eligible employer + free student loan coaching and assistance navigating the PSLF program.
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer.
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