Top 154 Clinical documentation specialist Jobs in Summit, Nj

Clinical Documentation Specialist, Level 1
NYC Health + Hospitals —New York, NY
- $119,696 a year
- Online Application
- Nursing
- RN License
- Hospital
- Commuter assistance
- Paid holidays
Clinical Documentation Specialist - Level II
NYC Health + Hospitals —New York, NY
- $131,664 - $156,567 a year
- Online Application
- Nursing
- Management
- RN License
- Commuter assistance
- Paid holidays
Documentation Improvement Specialist (On site work required)
NewYork-Presbyterian Hospital —New York, NY
- $101,000 - $151,000 a year
- Full-time
- Nursing
- RN License
- Hospital
- Opportunities for advancement
2d
Clinical Documentation Specialist HIM
CareWell Health —East Orange, NJ
- $110,000 - $120,000 a year
- Per diem
- Medicine
- RN License
- Computer literacy
- Paid holidays
- Disability insurance
Quick Apply
Clinical Document Specialist - PD
Holy Name Medical Center —Teaneck, NJ
- $45.50 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Free parking
- Health insurance
Clinical Criteria Escalations Specialist
Tennr —New York, NY
- $95,000 - $115,000 a year
- Full-time
- Hybrid work
- RN License
- Mid-level
- Office
- Parental leave
- 401(k) matching
8d
Coder Auditor/Senior CDI Specialist
HAMASPIK CHOICE INC —Brooklyn, NY
- $83,000 - $90,000 a year
- Full-time
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
OR Circulator Registered Nurse
Redefine Management, LLC —Hackensack, NJ
- $52 - $58 an hour
- Full-time
- RN License
- BLS Certification
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
School Nurse ( RN ) 26/27 SY - $55-$58- Peds Exp Preferred
KindSpire Education —East Orange, NJ
- $50 - $52 an hour
- Travel nursing
- School experience
- Nursing
- Anatomy knowledge
- Travel reimbursement
- Free parking
Quick Apply
Registered Nurse
HEARTSHARE HUMAN SERVICES OF NEW YORK —Far Rockaway, NY
- $46 - $50 an hour
- Part-time
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
Clinical Documentation Specialist RN
Hackensack Meridian Health —Hackensack, NJ
- From $97,011.20 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
Documentation Improvement Specialist (CDI) - HYBRID (4 days in Queens office)
NewYork-Presbyterian Hospital —New York, NY
- $101,000 - $151,000 a year
- Full-time
- Nursing
- RN License
- Physical & Rehabilitation Medicine
2d
Senior Consultant - Clinical Documentation Specialist
Deloitte —Morristown, NJ
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Clinical Informatics Specialist
Latent —New York, NY
- $75,000 - $100,000 a year
- Full-time
- Continuous improvement
- Quality control
- Epic
Physician Educator III
University HealthCare Alliance —Newark, NJ
- $44.13 - $57.36 an hour
- Full-time
- Remote
- Research
- High school diploma or GED
- Clinic
Associate Medical Records Specialist
NYC Health + Hospitals —New York, NY
- $72,615 a year
- Online Application
- Hospital
- Mid-level
- High school diploma or GED
- Commuter assistance
- Paid holidays
Medical Records Specialist
Alliance Health Systems —Matawan, NJ
- $20 - $25 an hour
- Full-time
- Hybrid work
- Background check
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
3d
Senior Grievance & Appeals Specialist, Clinical
VNS Health —Manhattan, NY
- $93,400 - $116,800 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Continuing education credits
- Paid holidays
10d
Revenue Cycle Specialist-Revenue Integrity Pathology-REMOTE
Weill Cornell Medicine —New York, NY
- $32.69 - $36.76 an hour
- Remote
- Surgery
- Research
- Mid-level
Credentials Specialist (Manhattan)
NYU Langone Health —New York, NY
- $66,299.99 - $81,375.00 a year
- Word processing
- Mid-level
- 3 years
- Wellness program

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Clinical Documentation Specialist, Level 1

NYC Health + Hospitals -
New York, NY

Apply Now

Job Details

Full-time
$119,696 a year

Benefits

Commuter assistance
Paid holidays
Health insurance
Pension plan
Union benefits
Employee discount
Loan forgiveness

Qualifications

Optimizing workflow processes
Statistics
Nursing
RN License
Medical statistical report preparation
Certified Nurse Practitioner
Bachelor of Science
Data quality assurance
Regulatory compliance
Medical billing and coding coordination with healthcare providers
Performance Reporting
Care documentation
Mid-level
Quality reports
Quality control data reporting
Acute care facility experience
Health information performance improvement
Clinical staff training
Records management
Bachelor's degree
Nurse Practitioner (NP)
Case management
Clinical training
Health information data integrity
Clinical staff mentoring
Data quality monitoring
Clinical program data analysis
Health record chart audits
Medical record abstraction
Continuous clinical improvement initiatives

Full Job Description

About NYC Health + Hospitals

Harlem Hospital Center has been a bedrock of the Harlem community since 1887. The hospital provides a wide range of medical, surgical, diagnostic, therapeutic and family support services to the residents of Central Harlem, West Harlem, Washington Heights and Inwood. Harlem is the largest hospital in the area, capable of treating the most seriously ill. Harlem provides over 90 specialized ambulatory care services, dentistry and oral surgery, behavioral health services, and community substance abuse treatment.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Work Shifts

9:00 A.M – 5:00 P.M

Duties & Responsibilities

Purpose of Position:

Under the direction of the Director of Clinical Documentation, Director of Health Information Management or a designee for revenue management and recovery, facilitates and obtains appropriate physician documentation for clinical conditions or procedures to support the appropriate severity of Illness, expected risk of mortality, and complexity of patient care and to optimize reimbursement, ensuring patient centered quality care, optimal utilization of resources, service delivery and compliance with NYC Health + Hospitals, hospital, and all relevant regulatory policies, procedures, and standards of care for better outcomes and improved patient experience. Demonstrates effective communication, planning, and organizational skills and keeps current knowledge in the clinical documentation field and of all applicable regulations. All personnel perform related work and may perform tasks remotely, as authorized.

Under supervision, performs assigned duties related to reviewing, reporting, processing and quality assurance of clinical documentation.

Examples of Typical Tasks:

1. Facilitates improvement in the overall quality, completeness, accuracy, specificity and timeliness of physician clinical record documentation through extensive medical record review, query process, and effective communication with appropriate clinical and coding staff, and by utilizing computer programs and systems.

2. Obtains appropriate physician documentation for clinical conditions or procedures through extensive on-going interaction with physicians, other patient caregivers, and medical records coding staff to ensure the clinical documentation properly captures information describing patients’ acuity, severity of illness, and risk of mortality. Reflects the level of service delivered to patients is appropriate, complete, and accurate and supports appropriate reimbursement for the level of service rendered to all patients.

3. Completes concurrent and retrospective reviews of patient records for a specified patient population to evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, postadmission complications and procedures for accurate Diagnosis-Related Group (DRG) assignment and Case Mix Index (CMI), risk of mortality, and severity of illness.

4. Queries physicians for incomplete, inconsistent, unclear or conflicting health record documentation to clarify and resolve conflicting information in patient’s medical record prior to patient’s discharge; maintains a record of review and query activities and other appropriate records.

5. Provides feedback and completes follow-up review of patient medical record, to ensure points of clarification have been addressed and recorded in the patient’s chart, and to assign a working/updated or final DRG upon patient discharge and before final coding and quality reporting submissions, as necessary.

6. Identifies and reports areas of weakness that may impact financial opportunities, and works with Finance or other appropriate staff in resolution of problems.

7. Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement.

8. Assists with preparation and presentation of clinical documentation monitoring/trending reports for review with physicians and hospital leadership.

9. Assists in the orientation and training of new staff members, and provides continual guidance and mentoring, as required.

10. Educates providers on proper clinical documentation and coding guidelines and practices, and compliance and reimbursement issues on an ongoing basis. Advises on the impact of provider documentation on accurate reporting of a patient’s clinical information and reimbursement.

11. Attends and/or participates in staff, departmental and interdisciplinary meetings, LEAN efficiency/ process improvement events, training and quality assurance/performance improvement (QA/PI) activities.

12. Performs other related work, as assigned.

Minimum Qualifications

1.Valid New York State license and current registration to practice as a Registered Professional Nurse(RN) issued by the New York State Education Department (NYSED); and Bachelor of Science inNursing degree from an accredited college or university; and four (4) years of acute care experience;or
2.Valid New York State license and current registration to practice as a Nurse Practitioner (NP) issuedby the NYSED; and two (2) years of experience, as described in “1” above; or
3.Valid New York State license and current registration to practice as a Physician Assistant (PA)issued by the NYSED; and two (2) years of experience, as described in “1” above; or
4.Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or
5.Successful completion of education that leads to a medical degree; and two (2) years of experience,as described in “4” above.

Benefits

NYC Health and Hospitals offers a competitive benefits package that includes:

Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
Retirement Savings and Pension Plans
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
Loan Forgiveness Programs for eligible employees
College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs

How To Apply

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.

Apply Now

Refine Your Search

clinical documentation specialist jobs in summit, nj

Clinical Documentation Specialist, Level 1

Clinical Documentation Specialist - Level II

Documentation Improvement Specialist (On site work required)

Clinical Documentation Specialist HIM

Clinical Document Specialist - PD

Clinical Criteria Escalations Specialist

Coder Auditor/Senior CDI Specialist

OR Circulator Registered Nurse

School Nurse ( RN ) 26/27 SY - $55-$58- Peds Exp Preferred

Registered Nurse

Clinical Documentation Specialist RN

Documentation Improvement Specialist (CDI) - HYBRID (4 days in Queens office)

Senior Consultant - Clinical Documentation Specialist

Clinical Informatics Specialist

Physician Educator III

Associate Medical Records Specialist

Medical Records Specialist

Senior Grievance & Appeals Specialist, Clinical

Revenue Cycle Specialist-Revenue Integrity Pathology-REMOTE

Credentials Specialist (Manhattan)

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