Documentation Specialist Jobs

About The Position

Requirements

• Bachelors of Science in Nursing, OR NP or PA license.
• Current NYS License.
• CCDS required
• Proficient computer skills for Windows Microsoft Office Applications (Word, Excel, Power Point)
• Self-motivated, self-directed, and able to work independently with minimal supervision.
• Five years clinical experience in Acute Hospital setting.
• Minimum of 2 years inpatient CDI experience.
• Proficiency in ICD-10-CM and PCS Official Guidelines for Coding and Reporting
• Multitasking, excellent communication and critical thinking skills.
• Working knowledge of AHA Coding Clinics
• Working knowledge of encoder, ability to correct coding and re-drop bill.

Responsibilities

• Conducts timely DRG Appeals supporting the CHS DRG Appeals Shared Service.
• Analyzes denials and appeals cases as appropriate.
• Determines accuracy of coding based upon review of the medical documentation and application of the coding guidelines.
• Clinically validates diagnoses in question.
• Manages the complete appeals process through all levels of appeal according to payor contract.
• Initiates and follows through for all RAC and Third Party Payor denials at every level, reviews all denials with direct report for plan/strategy for appeal.
• Meets or exceeds appeal deadline completion times.
• Involves appropriate physicians in the appeal process, expanding into preparation for ALJ and DRA.
• Follows up on Third Party Payor responses to all appeals and updates RAC and Third Party Payor focus studies, as well as Epic revenue cycle with attention to detail.
• Communicates denial issues with site HIM/CDIP Department and patient accounts.
• Continuously evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation, clinical validation for inpatient diagnoses that impact code selection, resulting DRG, and payment.
• Communicates with physician advisor, or attending physician verbally or through written methodology to validate diagnosis in question and support appeal.
• Provides feedback to HIM management staff and CDI leadership regarding opportunities for documentation improvement.
• Participates with the planning and development of educational programs directed towards improving documentation.
• Participates in education programs to maintain up to date coding skills.

Benefits

• Generous benefits packages
• Generous tuition assistance
• Defined benefit pension plan
• Culture that supports professional and educational growth