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Clinical Documentation Specialist

IT & IS | San Francisco, CA | Full Time, Contract, and Temporary

Job Description

Clinical Documentation Specialist 809318

Involves the evaluation of physician documentation, utilizing clinical expertise to ensure that the patient’s severity of illness and risk of mortality are accurately portrayed in the medical record for specificity and increased coding accuracy. Interacts with physicians, clinical staff, and health information management professionals. Works with coding staff to ensure that documentation of discharge diagnoses and any co-existing co-morbidities are a complete reflection of the patient’s clinical status and care.

Technical leader with a high degree of knowledge in the overall field and recognized expertise in specific areas; problem-solving frequently requires analysis of unique issues / problems without precedent and / or structure. May manage programs that include formulating strategies and administering policies, processes, and resources; functions with a high degree of autonomy.

Responsibilities:

  • Reviews denials and writes appeal letters for Benioff Children’s Hospital - SF
  • Conducts timely reviews of clinical documents in highly-complex cases, evaluating quality measures, consistency, completeness of documents, and accuracy for severity of illness (SOI) and risk of mortality (ROM).
  • Analyzes highly-complex and second-level clinical case data to identify trends, errors, inconsistencies, variances, or red flags that may delay or hinder third-party reimbursement. Recommends timely and effective strategies for revising DRG codes or correcting clinical documentation to resolve problems and improve compliance.
  • Monitors, evaluates, and reports changes and updates in regulations and guidelines affecting clinical documentation. Reviews and analyzes inpatient records for appropriateness and compliance with all federal, state, and other regulatory requirements.
  • Maintains current knowledge of all issues related to appeals, denials, coding, diagnosis, treatment, and reimbursement.
  • Serves as an expert resource to all levels of clinical staff and participates in the development of curriculum for in-service trainings and education of professional staff to achieve improved results in clinical documentation and appropriate reimbursement.

Qualifications:

  • Two years experience writing appeal letters to payors
  • Advanced knowledge and experience with the clinical and operational issues involved with pediatric and obstetric inpatient care, including the diagnoses, treatments, medical procedures, case management, discharge, and other practices that are part of effective clinical care systems.
  • In-depth understanding of the concepts, principles, practices, and regulatory requirements of accurate clinical documentation and medical record review, including SOI, ROM, HIMS, ICD-10 coding, DRG systems, standards of compliance, relevant Medicare Part A and Part B guidelines and other reimbursement processes.
  • Advanced knowledge of data collection, analysis, and reporting techniques and systems, and of health care information management systems related to clinical care, documentation, reporting, and reimbursement.
  • Advanced organizational and project management skills, with the ability to lead a team, prioritize tasks, and see highly-complex projects through from inception to completion on schedule.
  • Advanced critical thinking and problem-solving skills to manage multiple levels of information and responsibilities, and quickly assess highly-complex problems to develop an expedient path of resolution.
  • Advanced interpersonal and educational skills, with the ability to collaborate effectively on complex projects with clinical-care professionals, and to provide education, training, and resources on coding, reimbursement, and other clinical documentation issues.
  • Advanced skills in written and verbal communications, with the ability to interpret and convey complex clinical and technical information in a clear, concise manner, and to make cogent appeal letters, presentations, analyses, and reports.
  • In-depth ability to collaborate effectively with senior staff and management across departments and to provide counsel and guidance on highly-complex issues of functionality, clinical quality, efficiency, and program development.
  • Computer proficiency in relevant multiple technology applications. 1-2 years Clinical Documentation Improvement or Quality Improvement experience, preferably at a large Academic Medical Center.

Education:

  • Bachelor's degree in nursing or related area, and / or equivalent combination of experience / training. Master’s degree or higher in a healthcare related field (i.e. MSN, MD, MPH, or PharmD) preferred
  • Licenses: Active RN license in any state

$70 Per Hour          Remote           1 Month Assignment