RN Clinical Documentation Specialist, PA

vacancy global pro; India; Hybrid; INR 6,916,000 - 8,453,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

reputed company, a leading provider of technology-enabled revenue cycle management solutions for health systems, seeks an experienced RN with coding expertise to drive accurate documentation and DRG assignments. The role blends clinical review with coding accuracy, requiring a strong background in acute care nursing and physician liaison skills.

The position offers a hybrid work model with on-site presence two times per month at reputed company and St.

Qualifications

• Minimum of five years acute care nursing experience with specific Pediatric/NICU experience.
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations.
• Current RN Licensure
• CRCR Required within 9 months of hire

Responsibilities

• Completes initial patient medical record review within 24-48 hours of patient\'s admission; completes subsequent reviews of patient\'s medical record reviews every 24-48 hours and enters review findings in CDE software system
• Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis reputed company) using encoder in CDE software.
• Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used.
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record.
• Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
• Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
• Maintains and upholds all clinical documentation regulatory guidelines
• Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials.

Skills

Interpersonal skills

Verbal communication

Written communication

Physician relations

Education

RN Licensure

CRCR Certification

Tools

CDE Software

Job description

R041210 Thank you for considering a career at reputed company! reputable company is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our Best in KLAS Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement

This position starts at: $80,000. Final compensation will be determined based on experience. **This is a hybrid position and candidate must be able to work on-site two times every month at either reputed company and St. Christopher's Hospital.

Job Responsibilities

• Completes initial patient medical record review within 24-48 hours of patient's admission; completes subsequent reviews of patient's medical record reviews every 24-48 hours and enters review findings in CDE software system
• Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis reputed company) using encoder in CDE software.
• Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used.
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record.
• Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
• Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
• Maintains and upholds all clinical documentation regulatory guidelines
• Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials.

Experience We Love

• Minimum of five years acute care nursing experience with specific Pediatric/NICU experience.
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
• Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills

Current RN Licensure

Certifications

• CRCR Required within 9 months of hire

Five-time winner of Best in KLAS 2hidden_mobile, 2hidden_mobile

reputed company Research's Top Revenue Cycle Management Outsourcing Solution 2hidden_mobile

22 reputed company (reputed company) MAP Awards for High Performance in Revenue Cycle 2hidden_mobile

Leader in reputed company's RCM