- Utilization Management
- Clinical Documentation Improvement
Reviewing clinical documentation to facilitate the accurate representation of the severity of illness, expected risk of mortality, and complexity of care by improving the quality of the physician's clinical documentation. This work involves extensive record review and interaction with physicians, HIM/Coding professionals, nursing staff, and case management. Through collaboration with Coding professionals, educates the patient care team on changes in documentation guidelines and/or documentation deficiencies noted. The patient care team includes but is not limited to: attending physicians, consultants, physician extenders, allied health practitioners, nursing, and case management. The Specialist reports to the Clinical Documentation Improvement Director.
MINIMUM EDUCATION REQUIRED:
Associate's Degree from a program of nursing, BSN preferred, or Associate's Degree in Health Information Management
MINIMUM EXPERIENCE REQUIRED:
Minimum of five (5) years of recent hospital experience/practice, preferably in an ICU, CCU or complex Med/Surg environment.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
A current state Registered Nurse license or Certified Coding Specialist, RHIT, RHIA, OR CCDS. Bachelors preferred. Previous clinical documentation improvement experience, utilization management, precertification, coding, Medicare regulations, quality assurance, or related area preferred. Knowledge of DRG, ICD-9/10 and CPT coding relative to physician clinical documentation within electronic medical records preferred. Prior experience with Epic preferred.