You’ll need
Licensure
✓RN-Registered Nurse - DORA - Department of Regulatory Agencies Required
Certifications
CDI or Coding certification preferred
Education
✓Bachelor's Degree Nursing or related field (or Associates Degree with equivalent level of additional experience) Required
Qualifications
✓7-9 years of nursing experience with at least 2 years in an acute care setting Required and
✓1-3 years of CDI, clinical coding, DRG coordination, Medicare/Medicaid reimbursement experience. This experience can be included in the 7-9 years above. Required and
✓Knowledge of clinical criteria, pathophysiology, evidence-based practice and the ability to stay current on new trends in medical treatment. Ability to articulate concepts to physicians and other health care professionals in an effort to educate on clinical documentation requirements.
✓Must be able to demonstrate clinical expertise in areas of urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care.
✓Strong communication skills in order to successfully communicate complex ideas across different groups and educate on areas of needed improvement.
✓Ability to act as a translator between clinical and non-clinical teams.
✓Ability to work collaboratively with diverse groups and to effectively persuade and lead individuals/groups toward consensus.
✓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.
✓Knowledge of CMS Medicare, Medicaid, Managed Care and Commercial health plan billing, reimbursement and regulations.
✓Knowledge including but not limited to, value-based purchasing, bundled payments, accountable care organizations and readmission reduction program, and public reporting of quality outcomes.
✓Possess strong critical thinking with the ability to autonomously prioritize work, manage time, and maintain organization to support efficiency and effectiveness.
✓Knowledge of ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Coding Clinics, and other guiding references for coding accuracy and compliance.
✓Knowledge of quality measures, patient safety indicators, value based purchasing, risk adjustments, mortality scoring, hospital acquired conditions, CMS 5 star, and external publicly reported quality metrics.
✓Knowledge of compliance, practice briefs, white papers, and other publications guiding ethical and legal practices of CDI.
✓Proficient with multi-platform computer software and applications in order to utilize tools appropriately to track, analyze, calculate, and summarize data and qualitative findings. Proficient with Microsoft suite.
1-3 years of experience in education or supervisory experience preferred
Benefits
Medical, dental and visionPaid time offTuition assistancePaid parental leave
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About the role
Perform complex clinical documentation of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of provider documentation.
What you’ll do
Perform complex clinical documentationPerform complex clinical documentation of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of provider documentation.
Draft and submit writtenDraft and submit written queries to providers to achieve the necessary documentation clarification to achieve accuracy, specificity, and compliance of provider documentation.
Develop and deliver aDevelop and deliver a formalized CDI orientation process, leveraging industry-endorsed content, adult learning methodologies, and subject matter expertise to train new team members.
Develop and perform anDevelop and perform an internal auditing process in partnership with the CDI Manager to validate query compliance and surface educational opportunities to inform the CDI continuing education plan.
Educate providers, coder, andEducate providers, coder, and the CDI team regarding clinical documentation concepts, health data, quality outcomes, and compliance regulations.