Outpatient CDI Specialist/Charge Master

Redeemer Health•Abington Township, PA

About The Position

Joining Redeemer Health means becoming part of an inclusive, supportive team where your professional growth is valued. Our strength comes from bringing different perspectives and talent to our workforce, spanning PA & NJ. We offer programs that set up new team members for long-term success including education assistance, scholarships, and career training. With medical and dental coverage, access to childcare & fitness facilities on campus, investment in your retirement, and community events, your career at Redeemer is more than a job. You’ll discover a commitment to quality care in a safe environment and a foundation from which you can provide and receive personalized attention. We look forward to being a part of your professional journey. We invite you to apply today. SUMMARY OF JOB The Outpatient Clinical Documentation Specialist (“OP CDS”) Charge Master position is responsible for activities which improve the accuracy of facility outpatient clinical documentation and charging. The OP CDS assists clinical areas to document services and understand the relationship of documentation, medical necessity, and charging for services provided in accordance with hospital policies and procedures. This position actively reviews medical record documentation to ensure it aligns with coding and charging guidelines by payer policy, detects inaccuracies, and communicates issues to the OP CDI Supervisor, and ensures practices are put into place to mitigate inaccuracies. The OP CDS also provides support of the Denial Tracking system, in accordance with regulatory guidelines and plan policies, and provides coding and billing support to ancillary clinical departments and adjunct hospital entities. This position works with average daily revenue of $2.5 million, and aims to reduce denials by 2.1% of net revenue. CONNECTING TO MISSION: All individuals, within the scope of their position, are responsible for performing their job in light of the Mission & Values of the Health System. Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in all interactions with patients, residents, families and one another in the services we provide.

Requirements

Minimum of 3 years inpatient and/or outpatient coding experience. Will consider experienced clinical caregivers/managers, and/or revenue management/revenue cycle professionals
General knowledge of coding/classification systems appropriate for outpatient, charging, Charge Description Master (CDM) and/or inpatient, and APC and/or DRG prospective payment system and reimbursement structures.
Knowledge of CMS, Medicaid and third party payer coding, billing and compliance regulations required (MS-DRG, ICD-10-CM, HCPCS, CPT, Modifiers, etc.)
Experience reviewing and refuting payer denials by applying applicable coding and clinical supporting evidence specific to the denial.
Experience with 3M Encoder and computerized abstracting system.
Demonstrated strong interpersonal relationships to effectively communicate with all levels within the organization
Good problem solving and investigative skills.
Proven organizational skills to initiate and maintain efficient work flow.
Ability to organize and coordinate multiple functions and tasks.
Ability to use Microsoft Excel and Power Point Presentations and databases such as Power - BI (i.e. Data Analytics Management system).
Ability to utilize multiple hospital application systems (Soarian Clinical/Financial, Athena, inovalon, etc.).
Ability to work with minimum supervision at a high level of motivation and initiative while being entrepreneurial, creative and results oriented. Capacity to work independently.
Must possess an Associate/Diploma Degree in Health Information Technology (HIT) or Medical Assisting or Nursing (RN or LPN), or/and advanced degree in Health Information Management or the medical field.
Must possess one of the below: Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) Certified Coding Specialist (CCS). Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Professional (CDIP). Or 3-5 years of auditing experience or other employment that required auditing and training for Inpatient and Outpatient Hospital Medical coding.
Registered Nurse (RN), Licensed Practical Nurse (LPN)

Responsibilities

Improve the accuracy of facility outpatient clinical documentation and charging.
Assist clinical areas to document services and understand the relationship of documentation, medical necessity, and charging for services provided in accordance with hospital policies and procedures.
Actively reviews medical record documentation to ensure it aligns with coding and charging guidelines by payer policy, detects inaccuracies, and communicates issues to the OP CDI Supervisor, and ensures practices are put into place to mitigate inaccuracies.
Provide support of the Denial Tracking system, in accordance with regulatory guidelines and plan policies
Provide coding and billing support to ancillary clinical departments and adjunct hospital entities.