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Clinical Documentation Integrity Specialist-Commitment Bonus
Location:
Durham, NC
Description:
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. About Duke Health's Patient Revenue Management Organization Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions. Duke Nursing Highlights: Duke University Health System is designated as a Magnet organization Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 Nurses. Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification. Duke University Health System has 6000 + registered nurses Quality of Life: Living in the Triangle! Relocation Assistance (based on eligibility) Occ SummaryCommunicates with and educates physicians, mid-level providers, patient resource managers, case managers, Hospital Information Management (HIM) Compliance Specialists, and other health team members to facilitate improvements in comprehensive and inpatient medical record documentation to reflect conditions present on admission, diagnoses, complications, and comorbidities (C Cs) and the clinical treatment plan for inpatients. Rounds with the physician and team, completes a review of the medical record for all Medicare, Medicare, and Self-Pay patients, and creates a clinical documentation record. Communicate with physicians to clarify information, obtain needed documentation, present opportunities for improvement, and educate the appropriate Diagnosis Related Group (DRG) based on the severity of the illness.Follows up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with HIM to develop physician education strategies to promote complete and accurate clinic documentation and correct session sessions for physicians and physician extenders. D demonstrates negative trends. Provides education and understanding of CCs, severity severity illness, risk of mortality, case mix, secondary diagnosis, and the impact of procedures on DRG, and can impart this knowledge to physicians and other health team members.Utilizes the appropriate clinical documentation system to identify opportunities and ensure the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes. Assists with completing CDI retrospective documentation through meetings with physicians and other clinicians for query responses and documentation or documentation clarification.Identifies the most appropriate principal diagnosis, and CCs accurately reflect the severity of the illness. Processes discharges by assigning and updating a working DRG and collating with HIM as necessary to ensure that the final DRG assignment is reflective of the optimal DRG, which reflects resource allocation.Acts as a consultant to Hospital Information Management (HIM) Compliance Specialists when additional information or documentation is needed to assign the correct DRG.When contacted by Hospital Information Management (HIM) compliance specialists concerning disagreements about DRG or incomplete documentation, they review the medical record and follow up with the physician, if appropriate, promptly. Works with Hospital Information Management (HIM) Compliance Specialists to ensure AR days remain in the targeted range.Review the chart with the coding manager and immediate supervisor if you are unable to reach an agreement with the Hospital Information Management (HIM) Compliance Specialists. Review inpatient medical records both concurrently and retrospectively for identified service and payer populations. Review all Medicare, Medicaid, and self-pay patients at the time of admission to verify the written admission order (IP, OBS, OPS) for accuracy and by the Hospital Utilization Management Plan and take appropriate action to ensure compliance with DOH and federal regulations. Ensures that orders are reflective of the patient's level of care, severity of illness and intensity of service, utilizing set criteria.Communicates and collaborates with DUHS billing entity (PRMO) to ensure that all admission orders written are accurately reflected in the billing system to ensure accuracy and congruence between the clinical and billing systems. Provides formal and informal education to physicians that will improve procedures and compliance with the plan.Provides ongoing utilization review for private payers for identified services, i.e., inpatient psychiatry and pediatric and adult bone marrow transplant units.Collaborates effectively with reviewers from third-party payers to ensure positive working relationships and avoid denials for payment secondary to medical necessity or lack of information during the current admission. Provides on-call support to the DUH Emergency Department (ED) to support the accuracy and timeliness of ED physicians. Support physicians and physician extenders in the determination and assignment of patient status. Provide education to ED physicians and physician extenders via informal and formal education sessions to ensure understanding of patient status and compliance with the Utilization Management PlanPrior Case Management and Utilization Review experience and/or trainingAdvanced communication and interpersonal skills with all levels of internal and external customers. Excellent written and verbal communication, critical thinking, creative problem-solving, and conflict management skills. Proficient organization and planning skills. Strong computer skills. Demonstrated knowledge of quality improvement theory and practice. Minimum Qualifications Education BSN, PA (Physician's Assistant), NP (Nurse Practitioner) or Doctorate degree in a medically related field required. Experience Three years of progressive healthcare experience in an acute care setting. Previous chart review experience (case management utilization review) is preferred. Excellent written and verbal communication, critical thinking, creative problem-solving, and conflict management skills, in addition to proficient organization and planning skills, are required. Demonstrated knowledge of quality improvement theory and practice. Degrees, licenses, and certifications Currently licensed and/or registered as a Professional nurse, physician assistant, or MD in the state of North Carolina is preferred. CCDS, CCS, or CDIP preferred.Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.PDN-9c0faaf6-1f7b-465c-b4a9-de784ec5eb4e
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More About this Listing: Clinical Documentation Integrity Specialist-Commitment Bonus
Clinical Documentation Integrity Specialist-Commitment Bonus is a Other Jobs Clinical Documentation Job at Duke Health located in Durham NC. Find other listings like Clinical Documentation Integrity Specialist-Commitment Bonus by searching Oodle for Other Jobs Clinical Documentation Jobs.
Clinical Documentation Integrity Specialist-Commitment Bonus is a Other Jobs Clinical Documentation Job at Duke Health located in Durham NC. Find other listings like Clinical Documentation Integrity Specialist-Commitment Bonus by searching Oodle for Other Jobs Clinical Documentation Jobs.