RN Clinical Documentation Improvement Specialist - Value Based Reimbursement

Guthrie Enterprise • Sayre, PA

10h • Onsite

About The Position

Responsible for conducting extensive analysis of patient health records to ensure complete and accurate documentation, as well as identification of diagnosis codes to properly reflect the severity of patient illness. Collaborates with and educates physicians to promote clear and concise documentation reflecting the level of patient services rendered, as well as ensuring appropriate reimbursement is received. This role involves facilitating accurate and complete clinical documentation in the medical record reflective of the level of services rendered. It also includes the identification of all diagnoses and secondary diagnoses to capture the severity of patient illness and ensure appropriate reimbursement is received for the level of services rendered, RAF/MRA, and quality measures, based on clinical documentation. The specialist will demonstrate understanding and thorough working knowledge of ICD-9-CM and ICD-10-CM coding guidelines, as well as medical terminology to capture the severity of patient illness and final code assignment. There will be extensive interaction with physicians, nursing staff, and other members of the health care team to ensure complete and accurate clinical documentation. The ability to project performance based on internal and external data, and project financial impact to the organization in relation to achieved or underachieved goals is crucial. This role will work collaboratively with clinical, financial, and operational leadership and must be able to communicate efficiently, and identify barriers to involved stakeholders. The specialist will educate members of the team regarding documentation needs, reimbursement issues, and performance improvement opportunities on an ongoing basis. This role performs interpretation of legislative regulatory requirements for value-based purchasing programs frequently. It also assists with the preparation, validation, management, and organization of clinical documentation monitoring/trending reports for physician and leadership review. Preparation of reports summarizing activities and performance metrics related to process improvement initiatives including but not limited to federal regulatory programs and value-based purchasing incentive programs. Participates in professional development activities and maintains professional affiliations, maintains confidentiality. Performs other duties as assigned.

Requirements

• Nursing diploma (RN) required.
• A minimum of 3 years clinical experience.
• Applicant will need the ability to organize and communicate effectively both verbally and in writing.
• Ability to comprehend coding guidelines in order to present and educate providers and leadership staff.
• Organize, prioritize, and manage time efficiently to meet reporting deadlines.
• Maintain accurate records.
• Read and understand patient records in order to correlate documentation and diagnosis application.
• Operate PC and other software as required to perform job duties.

Nice To Haves

• BSN Preferred.
• Additional coding knowledge or coding certification desirable.
• Experience with quality chart reviews, abstracting, and/or coding preferred.
• Working knowledge of office procedures and revenue cycle preferred.
• Experience working with electronic medical records is desirable.

Responsibilities

• Conducts extensive analysis of patient health records to ensure complete and accurate documentation.
• Identifies diagnosis codes to properly reflect the severity of patient illness.
• Collaborates with and educates physicians to promote clear and concise documentation.
• Ensures appropriate reimbursement is received for the level of patient services rendered.
• Facilitates accurate and complete clinical documentation in the medical record.
• Identifies all diagnoses and secondary diagnoses to capture severity of patient illness and ensure appropriate reimbursement.
• Demonstrates understanding and working knowledge of ICD-9-CM and ICD-10-CM coding guidelines, and medical terminology.
• Interacts extensively with physicians, nursing staff, and other members of the health care team.
• Projects performance based on internal and external data and financial impact to the organization.
• Works collaboratively with clinical, financial, and operational leadership.
• Communicates efficiently and identifies barriers to involved stakeholders.
• Educates team members regarding documentation needs, reimbursement issues, and performance improvement opportunities.
• Performs interpretation of legislative regulatory requirements for value-based purchasing programs.
• Assists with preparation, validation, management, and organization of clinical documentation monitoring/trending reports.
• Prepares reports summarizing activities and performance metrics related to process improvement initiatives.
• Participates in professional development activities and maintains professional affiliations.
• Maintains confidentiality.
• Performs other duties as assigned.

Benefits

• Up To $25,000 Sign On Bonus For Qualified RNs!

What This Job Offers

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