RN Clinical Documentation Improvement Specialist - Value Based Reimbursement

RN Clinical Documentation Improvement Specialist - Value Based Reimbursement - FT

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

Position Summary: 

Responsible for conducting extensive analysis of patient health records in order to ensure complete and accurate documentation, as well as identification of diagnosis codes to properly reflect 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. 

Education, License & Cert: 

A nursing diploma (RN) required. BSN Preferred. Additional coding knowledge or coding certification desirable. Expectation to obtain CPC certification within 1 year of hire. 

Experience: 

A minimum of 3 years clinical experience. 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. 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 as described. Maintain effective interpersonal relations. 

Essential Functions: 

• Facilitates accurate and complete clinical documentation in the medical record reflective of level of services rendered. 
• Identification of all diagnoses and secondary diagnoses to capture severity of patient illness and ensure appropriate reimbursement is received for level of services rendered, RAF/MRA, and quality measures, based on clinical documentation. 
• Demonstrates understanding and thorough working knowledge of ICD‐9‐CM and ICD‐10‐CM coding guidelines, as well as medical terminology to capture severity of patient illness and final code assignment. 
• Extensive interaction with physicians, nursing staff, and other members of the health care team to ensure complete and accurate clinical documentation. 
• Ability to project performance based on internal and external data, and project financial impact to organization in relation to achieved or underachieved goals. Will work collaboratively with clinical, financial and operational leadership Must be able to communicate efficiently, and identify barriers to involved stakeholders. 
• Educates members of the team regarding documentation needs, reimbursement issues, and performance improvement opportunities on an ongoing basis. 
• Performs interpretation of legislative regulatory requirements for value based purchasing  programs frequently. 
• Assists with 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. 

Other Duties: 

• Performs other duties as assigned.

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