Clinical Documentation Improvement Specialist I

Emory Healthcare•Atlanta, GA

1d•$45 - $52•Onsite

About The Position

Provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation of patient acuity and to support acute care services that were delivered. The goal of concurrent review includes facilitation of appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality. Specific reviews are both determined internally and by requirements/requests of external payers or regulatory agencies and play a significant role in reporting quality of care outcomes and in obtaining accurate and compliant documentation for billing of services rendered.

Requirements

Graduate of an accredited school of Nursing, or United States or International School of Medicine Education.
For RNs, candidates must have an active license. All nurses employed in roles requiring an unencipled nursing license must have a valid, active license or temporary permit approved by the Georgia Licensing Board.
Three years' experience in healthcare related field with strong clinical expertise and acumen.
Experience in an acute care setting (Critical Care, Medical/Surgical or Emergency department nursing preferred; or 2 years' experience in a specialty area).
Ability to perform light lifting (1-10 lbs) occasionally.
Ability to perform frequent sitting.
Ability to perform close eye work (computers, typing, reading, writing).
Awareness of potential environmental exposures including blood-borne pathogens, bio-hazardous waste, chemicals/gases/fumes/vapors, communicable diseases, electrical shock, latex, radiation.
Ability to use personal protective equipment, including respirators.

Nice To Haves

Highly qualified candidates (physician) may be considered in lieu of an RN license.
Recent clinical experience in an acute care setting.
2 years' experience in a specialty area.

Responsibilities

Provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation of patient acuity and to support acute care services that were delivered.
Facilitates appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality.
Conducts specific reviews determined internally and by requirements/requests of external payers or regulatory agencies.
Plays a significant role in reporting quality of care outcomes.
Ensures accurate and compliant documentation for billing of services rendered.