Clinical Documentation Specialist - Clinical (2 positions)
SUMMARY: The Clinical Document Improvement Specialist - Clinical 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. Collaborates extensively with physicians, nursing staff and other caregivers, as well as medical records coding staff, to improve the quality and completeness of documentation of care. Will also evaluate hospital admission criteria and conduct concurrent review of initial, regular, and extended stay reviews on a majority of admissions. Will serve as a 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 requires understanding of
Medicare, Medicaid, and commercial health plans, as well as 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); CCS certification
POSITION DETAILS: Full-time, 80 hours per pay period, M-F, 8-5