Profee Clinical Documentation Specialist (Remote)

University Hospitals • Cleveland, OH

20h • Remote

About The Position

The Professional Fee Clinical Documentation Specialist (CDS) will serve as an advisor and expert resource for providers to improve the clinical documentation accuracy, supporting patient complexity, risk profiles, and appropriate E/M levels for professional fee billing. The CDS primarily assists providers in identifying clinically relevant information and capturing the necessary clinical documentation to accurately reflect patient acuity. The Professional Fee CDS will focus on the recapture and identification of chronic conditions reflected in Hierarchical Condition Categories (HCCs), which directly impact the patient risk-adjusted profile (RAF score). They will also assist with highlighting opportunities based on the provider's medical decision-making to appropriately reflect the level of service provided for patient care. The Professional Fee CDS will be responsible for completing pre-visit and post-claim reviews, as well as providing clear communication and education to providers on their documentation, coding, and billing practices, in adherence to compliance standards set by governing entities such as CMS, AHA, etc. Pre-visit reviews identify documentation opportunities for providers to recapture previously documented HCC diagnoses or new suspect conditions. Post-claim reviews focus on E/M encounters and highlight opportunities based on a provider's medical decision-making and patient acuity to support appropriate E/M level assignments and any identified HCCs. The Professional Fee CDS will also coordinate with colleagues from the CDI Program or other members of the organization regarding education and training to improve clinical documentation based on findings from pre-visit and post-claim reviews.

Requirements

• High School Equivalent / GED (Required)
• 3+ years Coding and/or clinical documentation integrity (Required)
• Extensive clinical knowledge and understanding of pathophysiology (Required proficiency)
• Strong critical thinking skills and utilization of clinical knowledge to identify potential clinical indicators supporting patient acuity and clarifications of the medical record (Required proficiency)
• Excellent written and verbal communication skills (Required proficiency)
• Strong project management skills (Required proficiency)
• Strong interpersonal skills, with demonstrated success at communicating effectively with all levels of the organization (Required proficiency)
• Ability to work independently in a time-oriented environment (Required proficiency)
• Demonstrates skilled ability and comfort with electronic medical records (EPIC preferred) (Required proficiency)
• Proficient with personal computer applications (Excel, Word, and Power Point) (Required proficiency)
• Ability to build education material that is meaningful for providers and team members (Required proficiency)
• Strong problem-solving and investigative skills (Required proficiency)
• Certified Coding Specialist (CCS) (Required) or Certified Professional Coder (CPC) or CRC, or other coding or CDI credential (Required)

Nice To Haves

• Associate's Degree (Preferred)
• Registered Nurse (RN), Ohio and/or Multi State Compact License (Preferred)
• Licensed Practical Nurse (LPN), Ohio and/or Multi State Compact License (Preferred)

Responsibilities

• Coordination with Professional Fee CDI Program leadership and colleagues, fostering teamwork and utilizing strong team-building measures.
• Performs pre-visit chart reviews to assist in highlighting relevant documentation and diagnoses in compliance with governing policies and industry guidelines. Applies a “clinical detective” mindset to identify new HCC diagnosis capture opportunities based on appropriate clinical indicators for the patient. Also performs post-claim reviews focused on appropriate E/M level assignments and any opportunities related to level of service and HCCs.
• Uses performance and outcome data from third-party support or other sources to identify high-priority providers.
• Creates specialty-specific education on relevant topics as identified in data analytics and from clinical encounter reviews and post-claim education chart reviews.
• Develops and maintains a systematic education schedule and approach for providers in the hospital and clinic/office setting, including but not limited to complete documentation, appropriate diagnosis code selection, E/M level assignments, and updates to coding guidelines.
• Delivers ongoing feedback and education to communicate the importance of complete documentation and key concepts during regular clinic or provider meetings or on an individual basis, as needed.
• Upholds working knowledge and stays current on the latest CMS and industry guidelines, with a specific understanding of HCCs and their implications for documentation.
• Maintains strict confidentiality of all patients, employee, and physician information according to HIPAA guidelines.
• Shares in the organization’s vision, demonstrates its values, supports its philosophy, and is sensitive to its mission.
• Demonstrates knowledge of and follows departmental and hospital policies and physician office procedures.
• Seeks out opportunities for individual growth and development, including attending various meetings, conferences, courses, and seeking certifications, as required.
• Uses tact and sensitivity when communicating with patients, visitors, co-workers, and other personnel.
• Serves on department and/or institutional committees as requested.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct, and UH policies and procedures are in place to address the appropriate use of PHI in the workplace.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED