Job Description

Clinical Documentation Improvement Specialist - Clinical

SUMMARY: Conducts clinically-based concurrent and retrospective review of inpatient medical records to evaluate whether the clinical documentation is reflective of quality of care outcomes and reimbursement compliance for acute care services provided. Duties include focused APR-DRG studies, quality reviews, and high risk retrospective reviews. Collaborates extensively with physicians, nurse practitioners, physician assistants, nursing staff and other ancillary caregivers, as well as health information management coding staff, to improve the quality and completeness of documentation of care. Evaluates hospital admission criteria and conduct concurrent review of initial, regular, and extended stay reviews on a majority of admissions. Serves as an expert resource for RN case managers and care providers who assign the correct patient status and level of care, and support the medical necessity of services. Conducts new hire and ongoing education of medical staff, residents, nurse practitioners and physician assistants regarding high-quality clinical documentation guidelines and practices. Participates in performance improvement activities such as Maintenance of Certification (MOC) initiatives. Attends regular forums such as morning and afternoon rounds, and assists in the presentation, analysis and trending of statistical data for specific patient populations. Writes clinical appeal responses for APR-DRG denials. This position utilizes understanding of Medicare, MediCal, and commercial health plans. Must have excellent working knowledge of APR-DRG, Interqual, medical necessity criteria and performance improvement principles. Also requires knowledge of clinical conditions and procedures, medical terminology, and excellent working knowledge of ICD-10-CM/PCS (International Classification of Diseases, 10th Edition).

JOB REQUIREMENTS: Minimum education required: Bachelor’s degree in Nursing. Minimum experience required: 20 months in clinical documentation specialist position(s). Special Requirements: 1 year of clinical experience (may be internship or pre-degree); Certified Coding Specialist (CCS) certification required.

POSITION DETAILS: 2 openings, Full-time, 80 hours per pay period, M-F, 8-5

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