RN Specialist, Clinical Documentation at Denver Health in Denver, CO

Job description

We are recruiting for a mission-driven RN Specialist, Clinical Documentation to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department REVENUE INTEGRITY Job Summary Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director. Responsible for selected assignments based on internal or external department requests. Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary. Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record. Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies. Essential Functions : Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of patient status, charges, and billing. (25%) Reviewing & appealing clinical denials in accordance with current medical literature, CMS regulations and individual payer contracts, policies, or provider manuals. Consolidating trends and tracking outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (40%) Educating providers, coding, CDI, UM, Revenue Cycle, and other ancillary departments regarding documentation accuracy, specificity, and compliance with rules and regulations. (10%) Consolidating trends and tracking denial outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (15%) Working collaboratively with clinical and non-clinical departments across the organization to support process improvement and obtaining accurate and compliant billing practices (10%) Education : Associate's Degree Required Work Experience : 4-6 years Six years of experience as a nurse in a hospital environment Required and 4-6 years Three of the six years with the appropriate level of experience in one or a combination of the following medical documentation related function: clinical coding, case management, DRG coordination, physician education, Medicaid/Medicare reimbursement. Required Licenses : RN-Registered Nurse - DORA - Department of Regulatory Agencies Required Knowledge, Skills and Abilities : Must be able to demonstrate knowledge of the pathophysiology of the disease process. Must be able to demonstrate clinical expertise in areas of urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care. Must be able to communicate and interact tactfully with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively. Ability to read and interpret professional journals, financial reports, and legal documents as necessary. Ability to define problems collects and summarizes data, establish facts and draw conclusions. Possesses knowledge of clinical documentation and coding concepts, DRG assignments, Inpatient Prospective Payment System (IPPS) and CMS rules and regulations. Must also be able to demonstrate knowledge including but not limited to, value-based purchasing, bundled payments, accountable care organizations and readmission reduction program. Microsoft Office Excel and SharePoint Variety of documentation and coding programs. Shift Work Type Regular Salary $82,500.00 - $127,900.00 / yr Benefits At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parent