Remote - Clinical Documentation Integrity Specialist

Mosaic Life Care • Saint Joseph, MO

23h • Remote

About The Position

The Clinical Documentation Integrity Specialist works under the supervision of the Manager to complete basic to intermediate CDI reviews and re-reviews, submit queries to providers, and complete first- and second-level appeals. The role evaluates appeals in partnership with a physician advisor and performs denial tracking, patient rounding, mortality reviews, and second-level reviews. The specialist reviews clinical documentation, assigns ICD-10-CM/PCS codes, and determines the appropriate DRG in accordance with Official Coding Guidelines.

This position is remote only for candidates residing in Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, or Virginia. Remote work from other states is not permitted at this time.

Requirements

• Associate's degree in Nursing.
• Three years of clinical experience in an ICU or critical care acute-care setting.
• Registered Nurse (RN) state licensure or compact-state licensure in the state corresponding to the designated work location, required upon hire.
• Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) certification required within two years.
• Ability to input and retrieve data; speak clearly; answer phones; use precise hand-eye coordination and fine motor skills; and write well.
• Clinical skills.
• Ability to work with interruptions and flexibility in hours and workflow, foster teamwork, and promote service and quality.
• Excellent communication and critical-thinking skills.
• Knowledge of care-delivery documentation systems and related medical-record documents.
• Knowledge of age-specific needs, disease processes, and related processes.
• Ability to read and interpret medical records, analyze encoder instructions, and understand documentation.
• Ability to work independently, follow through, pay attention to detail, and prioritize work.

Nice To Haves

• Bachelor's degree in Nursing.
• One year of experience in clinical documentation integrity functions.

Responsibilities

• Conduct basic to intermediate initial, concurrent, and retrospective reviews of clinical documentation for selected admissions; initiate tracking and document findings.
• Abstract data from concurrent and retrospective charts and computerized data systems using documentation, Official Coding Guidelines, and Official Query Guidelines.
• Assign and update ICD-10-CM/PCS codes and baseline and working MS-DRG and APR-DRG classifications; review accounts promptly and document findings thoroughly in the CDI system.
• Identify documentation that needs clarification and communicate with providers using appropriate query tools to ensure the medical record accurately supports severity of illness and risk of mortality.
• Review clinical validation denials and analyze them for appeal recommendations.
• Write first- and second-level denial appeals in collaboration with a physician advisor.
• Complete second-level reviews, including mortality and quality reviews.
• Participate in staff training and departmental improvement activities, using quality audit results to initiate changes in practice.
• Communicate with coders to help ensure the correct DRG is assigned to each case and use their feedback for continuous self-improvement.
• Collaborate with interdisciplinary team members to support accurate coding documentation, including rounding with physicians and attending team conferences.
• Pursue professional development through webinars, online education, and online meetings.
• Achieve CDI quality and productivity goals.
• Perform other duties as assigned.

Benefits

• Concierge services.
• Employee lounge.
• Wellness programs.
• Free covered parking.
• Free on-site and virtual health clinics.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree