Clinical Support Auditor (IKC)

DaVita Kidney Care • Denver, CO

1d • $78,000 - $119,000 • Remote

About The Position

A detail-oriented, clinically trained Registered Nurse that can provide expertise, education, coaching, and guidance on clinical practice and documentation to improve our clinical outcomes and increase the quality of provider documentation for diagnosis evaluation and quality metrics. This individual will serve as a role model and facilitator within the clinical documentation integrity team and support the leadership team with the execution of the department's strategic goals. They are self-directed and possess advanced analytical skills, critical thinking, creativity, and the ability to anticipate and identify opportunities and potential problems.

Requirements

• Excellent analytical and critical thinking skills.
• Excellent verbal/written communication and interpersonal skills.
• Ability to work independently and as part of a team in a fast-paced environment.
• Associate's degree with a current active clinical license (RN) (required)
• CCDS-O or CDIP (required or must be obtained within six months of hire)
• CRC (required or must be obtained within one year of hire)
• 3+ years of clinical documentation improvement experience, coding experience, or equivalent (required)
• 1+ year of experience working with advanced practice providers as well as other clinical and non-clinical staff (required)
• Solid clinical background in evidence-based medicine, including chronic disease management and prevention.
• Experience in ICD-10 coding and documentation requirements and risk adjustment.
• Knowledge of compliant query writing/process.
• Ability to perform a comprehensive chart review of 20-30 medical records daily, with workload variations based on daily tasks.
• Technical experience using EMR systems.
• Proficiency in MS applications (Excel, Outlook, Teams, PowerPoint, Word)
• Motivated self-starter and creative problem-solver who is comfortable working in a fast-paced, dynamic environment.
• Expert-level knowledge of Medicare risk adjustment, documentation, and coding requirements.
• 2+ years experience of experience providing risk adjustment education or management.
• 4+ years experience developing educational content for clinical professionals, including NPs, PAs, RNs, and/or physicians, pharmacists, etc.
• Associate's degree in nursing required.
• Comfortable presenting via Teams or in-person
• Possess strong technical skills, including Excel, Word, PowerPoint and Outlook.
• Coding certification from AAPC or AHIMA professional coding association or additional coursework/experience in coding and Risk Adjustment.
• Expert experience working with Medicare Advantage programs and CMS Risk Adjustment model.
• Previous work experience in clinical documentation review or a clinical quality program.
• Experience developing and delivering clinical education and training.

Nice To Haves

• 5+ years of clinical experience as a Registered Nurse (adult-geriatric or family) (preferred)
• Ability to travel for on-site meetings 2-4 times per year.

Responsibilities

• Performs clinical chart reviews to ensure documentation accuracy by applying established clinical criteria for diagnosing medical conditions.
• Applies their clinical knowledge to evaluate how provider documentation, lab results, diagnostic information, and treatment plans translate into coded data.
• Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using a concurrent query process following ACDIS/AHIMA Guidelines for Compliant Query Writing.
• Communicate with providers and other healthcare team members to clarify information or provide additional documentation when needed.
• Work directly with clinicians to improve the overall quality and completeness of documentation through the query process and/or provider education (correct disease processes and disease severity, complexity, and acuity with an eye towards accurate medical coding).
• Collaborates with team members as part of the clinical review process to promote high accuracy and consistency of results.
• Meets accuracy and productivity metrics to ensure the team achieves established departmental goals.
• Communicates with DaVita leaders to address documentation issues and trends.
• Actively participates in all department meetings as scheduled.
• Conduct individual and large group educational sessions for clinicians and medical coders (or other staff as applicable).
• Partner with data analytics, coding, compliance and education departments for onboarding, ongoing and targeted education for all IKC APPs and IKC partner providers on documentation requirements for Medicare risk adjustment.
• Flexible and able to adapt to change based on departmental needs.

Benefits

• Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave

What This Job Offers

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