Top 35 Clinical documentation improvement specialist Jobs in Gaithersburg Md

Clinical Review Specialist
Healthcare Legal Solutions LLC —Washington, DC
- $45 - $50 an hour
- Nursing
- RN License
- Certified Nurse Practitioner
Quick Apply
Patient Care Specialist I (Part Time / Monday-Friday / Day Shift)
MedStar Health —Washington, DC
- $18.70 - $32.72 an hour
- Part-time
- English
- High school diploma or GED
- Continuous improvement
Part-Time Oncology Data Specialist - Certified (remote)
Guidehouse Managed Services LLC —Washington, DC
- $68,000 - $113,000 a year
- Part-time
- Remote
- 5 years
- High school diploma or GED
- Analysis skills
- Health savings account
- Paid holidays
EHR Application Support Specialist
iCallidus —Washington, DC
- $87,000 - $118,000 a year
- Full-time
- Remote
- Nursing
- RN License
- PMP
- Disability insurance
- Health insurance
Clinical Lab Information Specialist
Precision Medicine Group —Frederick, MD
- $83,200 - $124,800 a year
- Online Application
- 5 years
- Master's degree
- Bachelor's degree
Clinical Lab Information Specialist
Precision for Medicine —Frederick, MD
- $83,200 - $124,800 a year
- Online Application
- 5 years
- Master's degree
- Bachelor's degree
Quick Apply
Senior Consultant - Clinical Documentation Specialist
Deloitte —Washington, DC
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Medical Staff Coordinator, Day Shift, Medical Staff
Adventist HealthCare —Silver Spring, MD
- $22.64 - $30.63 an hour
- Full-time
- Microsoft Word
- Microsoft Outlook
- Hospital
- Free parking
- AD&D insurance
Senior EHR Specialist
Community Clinic Inc. —Silver Spring, MD
- $105,000 - $120,000 a year
- Part-time
- 5 years
- HIPAA
- Research
- Tuition reimbursement
- Paid time off
Quick Apply
Manager, Clinical Documentation Integrity
Adventist HealthCare —Gaithersburg, MD
- $105,664.42 - $158,496.00 a year
- Full-time
- Medicine
- Anatomy knowledge
- RN License
- Free parking
- AD&D insurance
Quick Apply
CLINICAL DOCUMENTATION IMPROVEMENT SPECIALIST/CDIS (ON-SITE)
LTSi - Laredo Technical Services, Inc. —Bethesda, MD
- $34 - $37 an hour
- 8 hour shift
- 5 years
- Research
- Mid-level
- Paid holidays
- Dental insurance
Quick Apply
Quality Assurance Specialist
Preventive Measures —Washington, DC
- $25 - $28 an hour
- Full-time
- Customer service
- Mid-level
- High school diploma or GED
Quick Apply
5d
Clinical Documentation Integrity Manager
Guidehouse Managed Services LLC —Washington, DC
- $102,000 - $170,000 a year
- Full-time
- Anatomy knowledge
- 3 years
- Bachelor's degree
- Health savings account
- Paid holidays
8h
Functional Analyst (Healthcare Business)
Kymber Consulting Group —Bethesda, MD
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Paid holidays
- Disability insurance
Health Systems Clinical Specialist Sr.
JP Systems, Inc. —Fairfax, VA
- $124,000 - $155,000 a year
- Full-time
- Remote
- Nursing
- Medicine
- Research
Quick Apply
8d
Coding Specialist
Healthcare Legal Solutions LLC —Washington, DC
- $25 - $30 an hour
- 3 years
- High school diploma or GED
- Analysis skills
Quick Apply
ECW Builder/Analyst (Contractor)
Mary's Center —Washington, DC
- $80 an hour
- Contract
- Nursing
- Primary Care
- Mid-level
Health Information Management Specialist- Gilchrist Inova (Fairfax, VA)
Gilchrist Inova —Falls Church, VA
- Full-time
- High school
- Customer service
- Word processing
Quick Apply
10h
Medical Clinical Reviewer / Clinical Program Specialist | Managing Consultant
Guidehouse Inc. —McLean, VA
- Full-time
- RN License
- 5 years
- Physical & Rehabilitation Medicine
- Health savings account
- Paid holidays
6h
Senior Health Systems Specialist
Gritter Francona —Washington, DC
- Full-time
- Remote
- Nursing
- Master's degree
- Supervising experience
- AD&D insurance
- Disability insurance
Quick Apply

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Clinical Review Specialist

Healthcare Legal Solutions LLC -
Washington, DC

Quick Apply

Job Details

$45 - $50 an hour

Qualifications

Report preparation
HIPAA compliance
Clinical skill development
HIPAA
Clinical staff training
Medical treatment knowledge
Clinical training
Data interpretation
Systems analysis
Staff development

Full Job Description

SUMMARY:

This position is responsible for maintaining proper clinical review and interpretation of medical records and claim documentation to assist with the appeals of denied insurance claims including drafting appeal letters based on clinical judgment and knowledge.

DUTIES AND RESPONSIBILITIES:

Utilizes TimeMatters to obtain work assignments and communicates claim notes in a clear, concise manner.
Examines and interprets medical records and claim documentation (such as EOBs and UB-04s) to appeal denied insurance claims for inpatient and outpatient services.
Applies clinical judgment and knowledge for medical necessity, admission, and other clinical reviews.
Drafts, reviews, and revises appeal letters, including from other staff.
- Confirms that the correct letter format, guidelines, and argument were used.
- Confirms letters are logical and easy to comprehend.
Ensures all necessary attachments are noted and included with appeal.
- Confirms the page number citations correspond with the medical record.
Turns around high dollar and/or short deadline cases in a timely manner.
Sends all appeals, follows-ups, and other forms of documentation within timely filing periods.
Abides by all HIPAA and other compliance rules and regulations.
Assists with development of clinical training materials for other staff.
Assists with clinical training of other staff.
Performs other related duties as assigned by management.

QUALIFICATIONS:

Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.
Certificates, licenses and registrations required:
- licensed as a Registered Nurse (including RN, APRN, CRNP), Nurse Practitioner (including CNP, LNP, NPC), Physician Assistant, Physician, or other qualified healthcare provider.
Other skills required:
- Knowledge in health, knowledge of current practices and documentation requirements regarding the care and treatment of the population served.
- Knowledgeable of HIPAA.
- Knowledge of administrative and data systems, procedures and processes for improving program effectiveness and efficiency.
- Knowledge of data collection, compilation, and reporting.
- Ability to prepare clear and concise reports.
- Ability to train, consult, and present improvement recommendations to staff, committees, and others.
- Ability to evaluate and analyze systems problems and make recommendations for corrective actions.

COMPETENCIES:

Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
Business Necessity – The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance.
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
External Working Relationships – Develops and maintains courteous and effective working relationships with clients, vendors and/or any other representatives of external organizations.
Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

Quick Apply

Refine Your Search

clinical documentation improvement specialist jobs in gaithersburg md

Clinical Review Specialist

Patient Care Specialist I (Part Time / Monday-Friday / Day Shift)

Part-Time Oncology Data Specialist - Certified (remote)

EHR Application Support Specialist

Clinical Lab Information Specialist

Clinical Lab Information Specialist

Senior Consultant - Clinical Documentation Specialist

Medical Staff Coordinator, Day Shift, Medical Staff

Senior EHR Specialist

Manager, Clinical Documentation Integrity

CLINICAL DOCUMENTATION IMPROVEMENT SPECIALIST/CDIS (ON-SITE)

Quality Assurance Specialist

Clinical Documentation Integrity Manager

Functional Analyst (Healthcare Business)

Health Systems Clinical Specialist Sr.

Coding Specialist

ECW Builder/Analyst (Contractor)

Health Information Management Specialist- Gilchrist Inova (Fairfax, VA)

Medical Clinical Reviewer / Clinical Program Specialist | Managing Consultant

Senior Health Systems Specialist

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DUTIES AND RESPONSIBILITIES:

QUALIFICATIONS:

COMPETENCIES:

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