Remote - Clinical Documentation Integrity Specialist

Mosaic Life Care; Minnesota; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Concierge services

Employee lounge

Wellness programs

Free covered parking

On-site and virtual health clinics

Job summary

Mosaic Life Care is seeking a CDI Specialist to perform basic to intermediate reviews of clinical documentation for admitted patients. You will submit queries to providers to ensure documentation supports severity of illness and risk of mortality, and update ICD-10-CM/PCS codes and DRG baselines.

You will contribute to quality and productivity goals, participate in staff training, and collaborate with a multidisciplinary team to drive accurate coding in a broad hospital setting.

Qualifications

• 3 Years - Clinical experience in an ICU/Critical Care acute care setting - Required
• Certified Clinical Documentation Specialist (CCDS) - Required within 2 Years
• Ability to input and retrieve data, speak clearly, answer phones, precise hand-eye coordination and writing skills
• Ability to work with interruptions and flexible hours/workflow, foster teamwork and promote service and quality
• Prolonged time at a computer screen, sitting
• Knowledge of care delivery documentation systems and medical record documents
• Read and interpret medical records, analyze encoder instructions, understand documentation
• Visual and hearing acuity

Responsibilities

• Complete basic to intermediate initial, concurrent and retrospective reviews of clinical documentation for selected admissions.
• Submit queries to providers to capture documentation supporting severity of illness and risk of mortality.
• Assigns and updates ICD-10-CM/PCS codes and DRG baselines and working DRGs.
• Complete second level reviews including mortality and quality reviews.
• Participate in staff training and departmental improvement activities.
• Collaborate with interdisciplinary team to ensure accurate documentation.
• Pursue professional development via webinars and online education.
• Achieve CDI quality and productivity goals.

Skills

CDI Review

ICU experience

Query tools

Education

Associate's Degree - Nursing

Bachelor's Degree - Nursing (Preferred)

Job description

Candidates residing in the following states will be considered for remote employment: Remote work will not be permitted from any other state at this time

Works under the supervision of the Manager to complete basic to intermediate CDI reviews and re-reviews, submit queries to providers, complete first and second appeal levels. Review and ICD-10-CM/PCS codes are assigned and appropriate DRG based on Official Coding Guidelines.

Conducts basic to intermediate initial, concurrent and retrospective reviews of clinical documentation for all selected admissions to initiate the tracking process and document findings. Abstracts data from concurrent and retrospective charts, as well as computerized data systems using documentation, Official Coding Guidelines and Official Query Guidelines.

Assigns and updates ICD-10-CM/PCS codes and baseline and working MS-DRG and APR-DRG DRG for accounts, reviewing in a timely manner and documenting thoroughly in clinical documentation integrity system.

Identifies need to clarify documentation in records and initiates communication with provider utilizing the appropriate query tools in order to capture the documentation in the medical record that accurately supports the patient’s severity of illness and risk of mortality.

Completes second level review including mortality reviews and quality reviews.

Participates in staff training and departmental improvement activities and uses the results of the quality of quality audits to initiate change in practice. Collaborates with other members of the interdisciplinary team to achieve accurate documentation for coding (example: rounds with physicians, attends team conference).

Assumes responsibility for professional development by participating in educational opportunities via webinars, online education and online meetings.

Achieves CDI quality and productivity goals.

Associate's Degree - Nursing - Required

Bachelor's Degree - Nursing - Preferred

Work Experience

• 3 Years - Clinical experience in an ICU/Critical Care acute care setting - Required
• Certified Clinical Documentation Specialist (CCDS) - Required within 2 Years Or
• Input and retrieve data, speaking clearly, answering phones, precise hand\eye coordination, fine motor skills and good writing skills.
• Ability to work with interruptions, and flexibility in hours and workflow, foster teamwork and promote service and quality.
• Prolonged time spent looking at computer screen and keyboarding, sitting.
• Knowledge of care delivery documentation systems and related medical record documents.
• Read and interpret from the medical record, analyze encoder instructions, understand documentation.
• Visual, hearing.

Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care.

Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more.