RN - SLR

Reid Hospital & Health Care Services, Inc.; United States; On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Daycare

Doordash

Daily Pay

therapy dogs

massages

Forbes rated Best Places to Work 2022

Job summary

Reid Health in Indiana is seeking a CDI Specialist to optimize reimbursement through documentation-supported coding. The role works with physicians, nursing, HIM coders, and others to ensure accurate, timely documentation and DRG assignment.

This on-site position requires ASN or higher in health information management, nursing licensure as applicable, and 2+ years in acute care or ambulatory settings. RHIA/RHIT/CCS/CCDS/CDIP or related certs are valued.

Qualifications

• ASN or Associate of Science in Health Information Management required.
• RN licensure applicable; RHIA/RHIT/CCS/CCDS/CDIP certifications valued.
• 2+ years in acute care or ambulatory setting.

Responsibilities

• Review inpatient records to assign principal diagnosis and DRG.
• Complete initial review within 24 hours of admission.
• Perform concurrent reviews to maximize specificity of coding.
• Collaborate with coding staff to ensure documentation supports coding.
• Provide CDI training to providers and participate in department projects.

Skills

Nursing background

Clinical documentation

Detail oriented

Education

ASN or Associate of Science in Health Information Management

Advanced Nursing degree preferred

Tools

RHIA

RHIT

CCS

CCDS

CDIP

LPN

RN

Job description

RN - SLR 7661 Clinical Documentation Integrity Schedule: Day Shift. 40 hours weekly. Monday - Friday, no holidays. Position onsite.

About the Position

Follows the American Health Information Management Association’s Ethical Standards for Clinical Documentation Professionals. The CDI Specialist works towards optimizing reimbursement. Optimization is the process of striving to obtain the highest possible payment to which the facility is legally entitled on the basis of coded data supported by documentation in the health record. The CDI Specialist works extensively with physicians, Advanced Practice Providers, Nursing, HIM Coders, and others to ensure timely and accurate documentation.

Overview of Responsibilities

• Concurrent and retrospectively reviews inpatient medical records to identify the most appropriate principal diagnosis and to assign a working DRG.
• Completes the initial review within 24 hours of admission.
• Completes concurrent reviews to ensure working DRG and all comorbid conditions are documented by the providers to the greatest specificity.
• Ensures documentation supports diagnoses.
• Collaborates with the coding staff concurrently and retrospectively to ensure the chart has all the necessary documentation to support the most accurate coding.
• Ensures the medical record reflects the patient’s severity of illness and risk of mortality.
• Sends compliant queries to providers for clarification regarding documentation.
• Reviews one-day stay and second surgical review cases each week.
• Provides in-person CDI training to providers one-on-one.
• Assists in other monitoring activities, special department projects, or other needs as determined by the department director.
• Provides ongoing CDS team learning opportunities through sharing of professional knowledge and journal articles.
• Maintains integrity and compliance in all chart reviews and CDI documentation and queries at all times.
• CDS will support and implement quality measures as identified by the department manager.
• This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities that management deems necessary.

Education & Experience

• Education Required: ASN or Associate of Science in Health Information Management.
• Education Preferred: Advanced degrees in Nursing or Health Information Management.
• Experience Required: 2 or more years of experience working in an acute care setting or ambulatory office setting.
• Experience Preferred: Previous experience in CDI.

Licensure & Certification

• Licensure: Registered Nurse as applicable.
• Certifications: RHIA, RHIT, CCS, Certified Clinical Documentation Specialist (CCDS), OR Certified Documentation Improvement Professional (CDIP), LPN, RN.

Our values of Excellence, Empathy, Integrity and Accountability are essential to exceed our customers' expectations. At Reid, we look for individuals who believe in our core values and demonstrate a genuine desire to make a positive impact to those we serve. We take pride in employing people who show up every day with a commitment to these values along with our mission and vision. We are one team working toward a common goal of providing outstanding customer care and service to our communities. If you have a calling to serve and are looking for meaningful and purposeful work, Reid Health is the place for you. Reid Health's inpatient hospital is a 189-bed, regional referral center with a Level lll Trauma Center and a Primary Stroke Center designation. Reid Health's outpatient services include more than 40 specialties and sub-specialties throughout an eight-county service area. With more than 3,100 employees, 100 volunteers, and 170 healthcare clinicians on staff, Reid Health believes in wholeness -- in body, mind, and spirit. The minute you step through Reid's doors, you'll be surrounded by friendly faces. Each of our employees plays an important role in the friendly and caring environment we call Reid Health. It's more than a place to work. Reid team members are involved in and care for our community, fostering a sense of belonging and camaraderie. They are the reason our patients feel safe and cared for. And they are the reason Reid Health is ranked among the best in quality care. Reid Health is looking to add to its family with service-minded individuals like you. Whether you come from a clinical background or simply want to work in an environment that allows you to pursue your passions of service to others, we have opportunities for people just like you. Find yourself at Reid Health.

• Daycare
• Doordash
• Daily Pay
• therapy dogs
• massages
• Forbes rated Best Places to Work 2022

Equal Employment Opportunity has been, and will continue to be, a fundamental principle at Reid Health. Therefore, Reid Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, national origin, citizenship, age, disability, sexual orientation, gender identity, veteran or military status, genetic information, or any other factor protected by law. This applies to all policies and procedures relating to recruitment and hiring, compensation, benefits, termination, and all other terms and conditions of employment.

Employment with Reid Health is on an 'at-will' basis. This means that either you or Reid Health may terminate the employment relationship at any time, with or without cause, and with or without notice.

Our hiring practices do require face to face interviews and on-site visits prior to offers of employment.