RN Clinical Documentation Specialist - Referrals

Ensemble Health Partners; Putnam (CT); Hybrid; USD 72.000 - 88.000; Vollzeit

Benefits dieser Stelle

Bonus incentives

Tuition reimbursement

Certifications

Comprehensive benefits

Career advancement

Zusammenfassung

Ensemble Health Partners in Putnam, CT is seeking an RN Clinical Documentation Specialist - Referrals to ensure complete and accurate physician documentation for severity of illness, ROM, and DRG assignments. You will review records within 24-48 hours of admission and collaborate with physicians and coding staff.

This role offers a base salary of $80,000 with bonus incentives and opportunities for certifications, tuition reimbursement, and career advancement.

Qualifikationen

• Five years acute care nursing experience or more.
• Current RN licensure in good standing.
• Excellent verbal and written communication skills.
• Ability to organize and present information clearly and concisely.
• Willingness to innovate and explore AI-enabled improvements.

Aufgaben

• Review patient records within 24-48 hours of admission and ongoing reviews every 24-48 hours; enter findings in CDE.
• Assign principal diagnosis, CC/MCC, SOI and ROM; code with ICD-10-CM and DRG using encoder.
• Clarify with physicians to obtain missing or conflicting documentation.
• Educate clinicians and care teams on CDI guidelines and documentation accuracy.
• Collaborate with coding and care coordination to ensure accurate DRG assignment.
• Prepare timely appeals with supporting clinical evidence and regulatory guidelines.
• Work with care coordination to resolve physician clarifications prior to discharge.
• Ensure compliance with clinical documentation regulations.

Kenntnisse

Interpersonal communication

Verbal communication

Written communication

Prioritization

Ausbildung

RN Licensure

Tools

CDE software

Jobbeschreibung

## RN Clinical Documentation Specialist - ReferralsApply: Putnam, CT: Full time: Posted Today: R052489**Thank you for considering a career at Ensemble!**Ensemble 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:****CAREER OPPORTUNITY OFFERING:*** Bonus Incentives* Paid Certifications* Tuition Reimbursement* Comprehensive Benefits* Career Advancement* The Base Salary for this role is $80,000The CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate.**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 Related Group) 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 medical/surgical, Intensive Care, or Emergency Department 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* Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.**Minimum Education*** Current RN Licensure**Certifications:*** CRCR Required within 9 months of hire