RN Specialist, Clinical Documentation
About The Position
We are recruiting for a mission-driven RN Specialist, Clinical Documentation to join our team! At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department REVENUE INTEGRITY Job Summary Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director. Responsible for selected assignments based on internal or external department requests. Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary. Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record. Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies.
Requirements
- Associate's Degree Required
- Six years of experience as a nurse in a hospital environment Required
- Three of the six years with the appropriate level of experience in one or a combination of the following medical documentation related function: clinical coding, case management, DRG coordination, physician education, Medicaid/Medicare reimbursement. Required
- RN-Registered Nurse - DORA - Department of Regulatory Agencies Required
- Must be able to demonstrate knowledge of the pathophysiology of the disease process.
- Must be able to demonstrate clinical expertise in areas of urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care.
- Must be able to communicate and interact tactfully with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively.
- Ability to read and interpret professional journals, financial reports, and legal documents as necessary.
- Ability to define problems collects and summarizes data, establish facts and draw conclusions.
- Possesses knowledge of clinical documentation and coding concepts, DRG assignments, Inpatient Prospective Payment System (IPPS) and CMS rules and regulations.
- Must also be able to demonstrate knowledge including but not limited to, value-based purchasing, bundled payments, accountable care organizations and readmission reduction program.
- Microsoft Office Excel and SharePoint
- Variety of documentation and coding programs.
Responsibilities
- Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of patient status, charges, and billing. (25%)
- Reviewing & appealing clinical denials in accordance with current medical literature, CMS regulations and individual payer contracts, policies, or provider manuals. Consolidating trends and tracking outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (40%)
- Educating providers, coding, CDI, UM, Revenue Cycle, and other ancillary departments regarding documentation accuracy, specificity, and compliance with rules and regulations. (10%)
- Consolidating trends and tracking denial outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (15%)
- Working collaboratively with clinical and non-clinical departments across the organization to support process improvement and obtaining accurate and compliant billing practices (10%)
Benefits
- Generous paid time off
- Fully paid parental leave
- Exceptional retirement contributions
- Comprehensive health coverage
- Nationally recognized well-being programs
- Tuition assistance
- Career advancement pathways
- Professional development
- Loan forgiveness eligibility
- Employer contributions
- Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
- 100% paid parental leave up to 6 weeks
- Immediate eligibility for retirement plans with employer contribution up to 9.5%
- Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
- Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
- Free RTD EcoPass (public transportation)
- Childcare discount programs & exclusive perks on large brands, travel, and more
- Tuition reimbursement & assistance
- Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
- Professional clinical advancement program & shared governance
- Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
