You’ll need
Licensure
✓A Registered Nurse (RN) license or MD diploma (or equivalent) required
Education
✓Bachelor's degree
Bachelor’s degree in health-related field, preferred
Qualifications
✓Three or more years of Clinical Documentation Integrity experience required, preferably at an AMC
✓Experience working within EPIC and 3M 360 Encompass CAC, required
✓Clinical experience sufficient to understand and communicate medical diagnoses and courses of treatment to professional and non-professional personnel, required
✓3+ years experience
✓Knowledge of coding guidelines and coding clinic, required
✓Knowledge of laws, rules and regulations regarding appropriate clinical documentation for Medicare, Medi-Cal, CCS etc
✓Strong leadership, supervisory, and training skills
✓Excellent critical thinking abilities
✓Resourcefulness and strong communication, organizational, and analytical skills
✓Ability to work effectively with physician/staff and interdisciplinary teams
✓Computer proficiency and proficiency in Word, Excel and PowerPoint, required
✓Skill in abstracting/interpreting medical information from patient records, required
✓Knowledge of computer word processing, database programs, and ability to write reports and do graphical analysis, required
✓Note: Skills may be subject to test
About the role
This role involves daily review of high-acuity patient records to identify potential and active payer denials, assess clinical validity, and to support denial prevention, analysis, and appeals across inpatient and outpatient settings; continuously communicating with department staff; educating physicians, residents, and mid-levels; and assisting with appropriate documentation strategies.