RN Clinical Documentation Specialist

divh2CDI Specialist/h2pThe CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate./ppJob Responsibilities:/pulliCompletes initial patient medical record review within 24-48 hours of patients admission; completes subsequent reviews of patients medical record every 24-48 hours and enters review findings in CDE software system/liliAssigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software./liliClarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used./liliEducates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record./liliPartners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters./liliCollaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge./liliMaintains and upholds all clinical documentation regulatory guidelines/liliFormulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials./li/ulpExperience We Love:/pulliMinimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience/liliExcellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations/liliAbility to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills/li/ulpMinimum Education:/pulliCurrent RN Licensure/li/ulpCertifications:/pulliCRCR Required within 9 months of hire/li/ul/div