Remote-Eligible Clinical Documentation Specialist

NYC Health + Hospitals; New York (NY); In loco; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

Lincoln Medical and Mental Health Center in the Bronx seeks a clinical documentation professional to optimize physician documentation, ensuring accurate severity of illness and appropriate reimbursement. The role emphasizes collaboration with health information management and physicians to maintain high quality records.

Required credentials include NY RN/NP/PA licenses or equivalent medical degree with experience in acute care, DRG assignment, and documentation improvement.

Competenze

• New York State RN, NP, PA licenses or equivalent medical degree.
• BSN preferred; multiple license paths acceptable.
• Experience in acute care and medical record review.
• Familiarity with DRG, CMI and reimbursement workflows.

Mansioni

• Improve physician documentation quality, completeness and timeliness through chart review and queries.
• Obtain documentation to accurately capture acuity, severity and mortality risk.
• Perform concurrent and retrospective reviews to support DRG assignment.
• Query providers for clarification; maintain records of reviews and queries.
• Provide feedback and follow-up on chart clarifications before discharge.
• Identify weaknesses affecting financial opportunities and coordinate with Finance.
• Analyze data trends to identify improvement opportunities and present findings.
• Assist in training staff and educating providers on coding guidelines.
• Participate in meetings and QA/PI activities; support remote work as needed.

Conoscenze

Clinical documentation

Analytical thinking

Communication skills

LEAN concepts

Formazione

Registered Nurse (RN) license NY

Bachelor of Science in Nursing (BSN)

Nurse Practitioner (NP) license NY

Physician Assistant (PA) license NY

Foreign Medical Graduate

Medical degree

Descrizione del lavoro

Lincoln Medical and Mental Health Center in the Bronx seeks a clinical documentation professional to optimize physician documentation, ensuring accurate severity of illness and appropriate reimbursement. The role emphasizes collaboration with health information management and physicians to maintain high quality records.

Required credentials include NY RN/NP/PA licenses or equivalent medical degree with experience in acute care, DRG assignment, and documentation improvement.