RN Specialist, Clinical Documentation

denverhealth; Denver (CO); On-site; USD 83,000 - 128,000; Full time

Benefits offered by this job

Paid time off

Parental leave

Retirement contributions

Health insurance

Tuition assistance

Job summary

Denver Health is seeking a mission-driven RN Specialist, Clinical Documentation to join our Revenue Integrity team in Denver, CO. The role focuses on concurrent and retrospective reviews to ensure documentation accuracy, billing compliance, and appropriate classification of patient status and charges.

You will educate providers on documentation specificity, query physicians as needed, and collaborate with Coding, HIM, Patient Safety and Quality, and Enterprise Compliance Services to support

Qualifications

• 4–6 years of hospital nursing experience.
• Experience in clinical coding, DRG coordination, or Medicaid/Medicare reimbursement.
• RN license (DORA) required.

Responsibilities

• Concurrent and retrospective reviews for documentation accuracy and billing compliance.
• Educate providers on documentation accuracy and query physicians as needed.
• Review and appeal clinical denials; track outcomes for Revenue Cycle reporting.
• Collaborate with CDI, HIM, UM, Revenue Cycle and other departments to improve billing practices.
• Participate in ongoing education on ICD-10, CMS rules and policies.

Skills

Communication skills

Nursing expertise

Medical documentation knowledge

Education

Associate's Degree

Tools

Excel

SharePoint

Job description

We are recruiting for a mission-driven RN Specialist, Clinical Documentation to join our team! We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey.

Our Values

• Respect
• Belonging
• Accountability
• Transparency

Department

• REVENUE INTEGRITY

Job Summary

Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director. Responsible for selected assignments based on internal or external department requests. Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary. Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record. Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies.

Essential Functions

• Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of patient status, charges, and billing. (25%)
• Reviewing & appealing clinical denials in accordance with current medical literature, CMS regulations and individual payer contracts, policies, or provider manuals. Consolidating trends and tracking outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (40%)
• Educating providers, coding, CDI, UM, Revenue Cycle, and other ancillary departments regarding documentation accuracy, specificity, and compliance with rules and regulations. (10%)
• Consolidating trends and tracking denial outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (15%)
• Working collaboratively with clinical and non-clinical departments across the organization to support process improvement and obtaining accurate and compliant billing practices (10%)

Education

Associate's Degree Required

Work Experience

• 4-6 years Six years of experience as a nurse in a hospital environment Required and 4-6 years Three of the six years with the appropriate level of experience in one or a combination of the following medical documentation related function: clinical coding, case management, DRG coordination, physician education, Medicaid/Medicare reimbursement. Required

Licenses

RN-Registered Nurse - DORA - Department of Regulatory Agencies Required

Knowledge, Skills and Abilities

• Must be able to demonstrate knowledge of the pathophysiology of the disease process.
• Must be able to demonstrate clinical expertise in areas of urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care.
• Must be able to communicate and interact tactfully with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively.
• Ability to read and interpret professional journals, financial reports, and legal documents as necessary.
• Ability to define problems collects and summarizes data, establish facts and draw conclusions.
• Possesses knowledge of clinical documentation and coding concepts, DRG assignments, Inpatient Prospective Payment System (IPPS) and CMS rules and regulations.
• Must also be able to demonstrate knowledge including but not limited to, value-based purchasing, bundled payments, accountable care organizations and readmission reduction program.
• Microsoft Office Excel and SharePoint
• Variety of documentation and coding programs.

Shift

Work Type

Regular

Salary

$82,500.00 - $127,900.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
• 100% paid parental leave up to 6 weeks
• Immediate eligibility for retirement plans with employer contribution up to 9.5%
• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
• Free RTD E