Clinical Documentation Integrity Specialist RN
About The Position
Opportunities with Reliant Medical Group, part of the Optum family of businesses. Join a community-based, multi-specialty, physician-led organization where you will work with talented peers on a common purpose: improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well-being as a team member. Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together. As the Registered Nurse, you will be responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and adhering to current standards of nursing practice. Communicates and coordinates effectively with all entities involved in the care of the patient to promote safe, high quality care. Making decisions reflecting critical thinking and evidence based nursing practice.
Requirements
- Graduate of a State-approved school of nursing
- Current, unrestricted, license to practice professional nursing in the Commonwealth of Massachusetts
- Certification as professional coder (CPC, CCS-P, CCS, CPC-H, CRC-risk, AAPC) or ability to obtain certification while working in the position
- American Heart Association Basic Life Support (BLS)
- 3+ years nursing experience with at least 3+ years of clinical experience with chronic disease patient population in an ambulatory or inpatient setting required.
- Computer experience with the ability to use word processing and spreadsheet programs
- Electronic medical record (EMR) experience and/or aptitude to master the EMR based on other technology experience
- Proven solid written communication skills
Nice To Haves
- Bachelor of Science in Nursing (BSN)
- Advanced Cardiac Life Support (ACLS) may be required based on specialty
- 2+ years of RN experience
- Proven solid critical thinking, problem solving, interpersonal and patient interviewing skills
- Proven ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care
- Proven ability to prioritize, multitask, and work in a rapidly changing environment with multiple demands
- Proven excellence in practice, documentation, and cost-effective care utilization. Maintains high patient satisfaction
Responsibilities
- Reviews encounters in the electronic medical record to ensure accuracy and appropriateness of clinician documentation using relevant risk adjustment program standards
- Utilizes abstract reports to substantiate HCC diagnoses that have been billed and/or are considered relevant but do not appear on the patient’s problem list
- Provides concurrent and retrospective abstraction for all Reliant Risk Adjustment programs
- Independently conducts chart reviews for supporting documentation of diagnosis codes which can be added to Problem List. Assigns accurate diagnosis codes to Problem List; follows standard work for adding diagnoses to Problem List
- Reviews new Reliant Medical Group patients for potential diagnoses supporting risk adjustment programs and updates problem list in the electronic medical record
- With coding education team, provides clinician training for risk adjustment programs. Ad hoc visits to clinical sites may be scheduled to enhance coordination of team-based care and to facilitate clinician education
- Participates in development, implementation, and monitoring of procedures that support organizational goals and business objective related to risk adjustment capture
- Utilizes thorough understanding of CMS/Medicare coding regulations as well as technical knowledge of ICD-10 and CPT systems
- Performs other duties as assigned
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
