Outpatient CDI Specialist

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POST DATE 3/25/2020
END DATE 4/6/2020

MedPartners Los Angeles, CA

Location
Los Angeles, CA
AJE Ref #
587028888
Job Classification
Full Time
Job Type
Regular
Company Ref #
64176
Experience
Mid-Career (2 - 15 years)
Education
Masters Degree

JOB DESCRIPTION

DESCRIPTION

TRAVEL ONSITE OUTPATIENT CLINICAL DOCUMENTATION INTEGRITY SPECIALIST
The Clinical Documentation Specialist is responsible for improving the overall quality and completeness of Outpatient clinical documentation by expediting clarification to clinical documentation. This is accomplished through ongoing interactions with physicians and other clinical staff to facilitate that the medical documentation in the patient medical record accurately and completely reflects the quality of care rendered to the patient. The accurate and complete medical record documentation will ensure that appropriate reimbursement is received for the level of service rendered to all patients and that information used for measuring and reporting physician and hospital outcomes is correct.

Position Overview:

* Complies with hospital, Outpatient department, and unit standards, including but not limited to safety, infection control, quality management, environmental, confidentiality, and patient care.

* Prioritizes work and provides prompt and efficient service.

* Improves the overall quality and completeness of clinical documentation by performing admission/continued stay reviews using clinical documentation guidelines.

* Educates all internal customers, including physicians, on clinical documentation opportunities and coding and reimbursement issues and quality and medical necessity documentation compliance.

* Assists medical and other patient care staff to identify the most accurate principal diagnosis and secondary diagnoses and chief complaint to accurately reflect severity of illness and risk of mortality in compliance with applicable payer requirement and government regulations.

* Confers with physicians to clarify information, obtain needed documentation, present education regarding the significant of appropriate documentation needed to support clinical severity and accurate coding.

* Conducts follow-up concurrent and retrospective medical record review to ensure that agreed-upon information has been included in medical record documentation.

* Confers with coding specialist and clinicians to ensure appropriate reimbursement for the level of service rendered to all patients with DRG based payers. Ensures the clinical information utilized in profiling and reporting outcomes is complete and accurate.

* Demonstrates competency in selected administrative skills. Includes but not limited to:

* Performs chart and/or data abstract reviews.

* Conducts concurrent review of CMSDNV measures and optimum DRG documentation.

* Working knowledge of ICD-10 coding/DRG assignment is required

* Interfaces with physicians for documentation clarification.

* Enters results of concurrent and retrospective reviews in computerized tracking and reporting system.

* Edits, complies and assists in analyzing data for studies, audits and other reports.

* Assists in training new personnel.

* Assist with care and maintenance of department equipment and supplies.

* Maintains department records, reports, and files as required.

* Demonstrates responsibility and accountability for own performance on team in regards to:

* Participates in the development and attainment of team, department and hospital goals including:

* Complies with hospital, department, and unit standards, including but not limited to safety, infection control, quality management, environmental, confidentiality, and patient care.

* Educates all internal customers, including physicians, on clinical documentation opportunities and coding and reimbursements issues and JCAHO/CMS measure compliance.

* Assists physicians and other care givers in the identification of the most appropriate principal diagnosis and chief complaint to accurately reflect severity of illness in compliance with applicable payer requirement and government regulations.

* Confers with physicians to clarify information, obtain needed documentation, present education regarding the significant of appropriate documentation needed to support clinical severity and accurate coding and JCAHO/CMS measure compliance.

Minimum Education and/or Experience Required: (Education Requirements and Experience):
Graduate of a National League of Nursing (NLN) or Commission of Collegiate Nursing Education (CCNE) accredited Masters of nursing program and licensed in the appropriate state. Minimum of five years' experience as a registered nurse. Demonstrated leadership skills/ability as well as project management skills. Requires the ability to coordinate/manage multiple projects and activities in a changing environment. Excellent communication, problem-solving and decision-making skills. Relevant experience includes lead roles, project/committee leadership, and/or supervisor experience.
Additional Experience and/or Qualifications: (Has Achieved Competency in the Following Areas, Job Knowledge and Additional Considerations): Computer experience in Word, Excel, Powerpoint. Previous experience with external accrediting bodies (e.g., NCQA, JCAHO) helpful. Previous supervisory experience beneficial. Master's degree in nursing administration, healthcare administration, business preferred. Knowledge of Medicare and Medicaid guidelines helpful. Understanding of managed care and commercial review experience helpful.

EXPERIENCE/QUALIFICATIONS:

* ICD-10 coding and CDI training

* One year or more CDI experience or two years or more of inpatient coding experience.

Licensure/Certification Required:

* IF RN, NP OR FOREIGN MEDICAL GRADUATE, EMERGENCY DEPARTMENT OR INTENSIVE CARE UNIT EXPERIENCE WITH ICD-10 TRAINING IS STRONGLY PREFERRED.

* CALIFORNIA LICENSED REGISTERED NURSE, NURSE PRACTITIONER, PHYSICIAN ASSISTANT, MD GRADUATE/EDUCATED IN FOREIGN COUNTRY, RHIA, RHIT OR CCS.

* CCDS AND OR CDIP STRONGLY PREFERRED.

Benefits:

* Salary Range: $83,000 to $93,600 per year

* 401k with match

* Paid Time Off

* Sick Time

* Medical, Dental, Life and Long/Short term disability Insurance.

* Paid Association Dues Paid

* Educational Benefits

Revenue Cycle Solutions formerly MedPartners and Peak and Peak offers opportunities for learning and career development; competitive pay; and a comprehensive benefits program.

We promote a diverse and inclusive workplace. Our team members have a voice in their work through surveys, pulses and town halls.

At Revenue Cycle Solutions, we value the role each team member plays in helping us deliver on our mission of making life better for our healthcare facilities.

We take pride in providing a rich and rewarding career opportunities that enable team members to reach their highest potential.

We invite you to learn more about Revenue Cycle Solutions.