Remote - Clinical Documentation Integrity Specialist

Mosaic Life Care; United States; À distance; USD 70 000 - 100 000; Plein temps

Résumé du poste

Mosaic Life Care is seeking a Clinical Documentation Improvement (CDI) Specialist to review hospital admissions, code ICD-10-CM/PCS, and support physician advisors on denials and appeals.

Requirements include an Associate's degree in Nursing (Bachelor's preferred), 3 years of ICU/critical care experience, and RN licensure. CCDS or CDIP certification is expected within 2 years of hire.

Qualifications

• Associate's Degree in Nursing required.
• Bachelor's Degree in Nursing preferred.
• 3 years clinical ICU/critical care experience required.
• 1 year experience in clinical documentation integrity preferred.
• RN licensure in state or compact required upon hire.
• CCDS certification required within 2 years or CDIP within 2 years.

Responsabilités

• Conducts initial, concurrent and retrospective reviews of clinical documentation for admissions; abstracts data from charts and systems.
• Assigns ICD-10-CM/PCS codes and baseline/working DRG/ APR-DRG.
• Identifies need to clarify documentation with providers via queries.
• Reviews denials and analyzes for appeal recommendations; prepares first and second level denial appeals.
• Collaborates with interdisciplinary team to ensure accurate documentation and coding.
• Participates in staff training and departmental improvement activities; aims for CDI quality and productivity goals.
• Other duties as assigned.

Connaissances

Data entry

Clinical skills

Communication

Critical thinking

Flexibility

Teamwork

Detail oriented

Keyboarding

Age-specific care

Formation

Associate's Degree - Nursing

Bachelor's Degree - Nursing

Description du poste

Description

Candidates residing in the following states will be considered forremoteemployment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia.Remotework 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. This position evaluates and partners with physician advisor on first and second level appeals, denial tracking. Rounding on patients, mortality reviews and second level reviews are also performed. Review and ICD-10-CM/PCS codes are assigned and appropriate DRG based on Official Coding Guidelines.

Responsibilities

• 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.


• Reviews clinical validation denials and analyzes for appeal recommendation. Writes first and second level denial appeals in collaboration with physician advisor. 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. Communicates with coders to ensure that the correct DRG is assigned to each case; receives feedback as a means of continuous self-improvement


• 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.


• Other duties as assigned

Education

• 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


• 1 Year - Experience in clinical documentation integrity functions - Preferred

Licenses and Certifications

• Registered Nurse (RN) - State Licensure/Or Compact State Licensure - State Licensure/Or Compact State Licensure in state, depending upon designated work location - Required Upon Hire


• Certified Clinical Documentation Specialist (CCDS) - Required within 2 Years Or


• Certified Documentation Improvement Practitioner (CDIP) - Required within 2 Years

Skills and Abilities

Essential Technical/Motor Skills

• Input and retrieve data, speaking clearly, answering phones, precise hand\\eye coordination, fine motor skills and good writing skills.


• Clinical skills.

Interpersonal Skills

• Ability to work with interruptions, and flexibility in hours and workflow, foster teamwork and promote service and quality.


• Excellent communication and critical thinking skills.

Essential Physical Requirements

• Prolonged time spent looking at computer screen and keyboarding, sitting.

Essential Mental Abilities

• Knowledge of care delivery documentation systems and related medical record documents.


• Knowledge of age-specific needs and the elements of disease processes and related processes.


• Read and interpret from the medical record, analyze encoder instructions, understand documentation.


• Function independently and have follow through skills, detail oriented. Ability to prioritize work.

Essential Sensory Requirements

• Visual, hearing.

Exposure to Hazards

Other Skills and Abilities