- Customizes and implements the concurrent review process.
- Educates members of the patient care team regarding documentation guidelines and regulatory requirements.
- Supports timely, accurate and complete documentation of clinical information.
- Formulates/assists with physician compliant query processes.
- Concurrently, enters working clinical diagnoses into the 3M Encoder to determine DRG status, including MC and MCCs.
- Participates in Utilization Review Committee and informs hospital committees of documentation changes and/or requirements developed by CMS and other regulatory agencies.
- Works with Revenue Cycle team to review charts <15>
- Works closely with other Quality Department members to help with other functions of Quality Department on an as needed basis.
- Facilitates the application from new and existing providers through all stages to enroll or re-validate the providers with commercial and/or Government payers, as well as facilities.
- Compiling of confidential data and communication with providers, payers and medical staff via email, phone, Teams and mail.
- Responsible for updating practitioner information in internal software and with external payers.
- Maintain the provider's online profiles, and conduct verification of all data, ensuring accuracy and timely entry
- Develops and maintains excellent working relationship with provider practices and health plan contacts regarding provider enrollment statuses.
- Investigates and resolves enrollment issues with health plans that are impending the accuracy of billing and reimbursement.
- Share essential updates with providers and the internal team in monthly summary reports or as often as necessary.
- High school graduate or equivalent.
- RHIT, RHIA or CCS required with a minimum of 3-5 years inpatient coding experience.
- AHIMA certification required and maintained.
- Graduation from a program of Nursing, BSN preferred with 2-3 years' experience in case management, including Utilization Review. Current Colorado RN license required and maintained.
- Thorough knowledge of DRG assignments, ICD-10 codes and regulatory coding guidelines.
- Advanced knowledge of anatomy & physiology, medical terminology, pharmacology, pathophysiology and disease processes.
- Excellent organization, analytical, writing and interpersonal skills.
- Self-directed with excellent critical thinking, problem-solving and deductive reasoning skills.
- Ability to communicate well with physicians and peers.
- Exhibits knowledge of clinical documentation requirements
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Clinical Documentation Specialist - Delta, United States - Delta Health
Description
Concurrently reviews medical records and assists physicians in removing the barriers between clinical and coding languages to allow more specific and complete documentation. Through interaction with the physicians and other members of the health care team, facilitates improvement in quality, completeness and accuracy of the medical record documentation to support severity of illness, expected risk of mortality and complexity of care of the patient. Will also be responsibility for maintaining active status for all providers by successfully completing initial and subsequent credentialing required for commercial payers, Medicare and Medicaid.
Delta Health is a county-wide healthcare system that has been serving the Western Slope for over 100 years. We have grown to a 49-bed hospital with locations throughout Delta County. We proudly provide a wide range of medical services that meet the diverse needs of our community members. At all stages of life, we are here to provide remarkable care in a healing environment.
Employee Benefits: Medical, RX, Dental, Vision, Retirement, PTO, and Scholarships towards continued education.
Medical: Low monthly premiums; 100% coverage for all services provided within our Delta Health System without a deductible or co-payment. We offer alternative coverage to include massage, acupuncture, and chiropractic care. Employer paid Life and Disability coverage.
Paid Time Off: 4 plus weeks of vacation (CAL) a year for Full-Time employees including sick pay and personal time off.
Retirement: 403B Plan -Up to a 3% retirement match.
