Clinical Documentation Specialist

UPDATE - Special Procedures/Unit Details:
***REQUIRED Experience:
20 reviews per day-minimum
20% query rate minimum
3M 360, Cerner, CDI experience (3+ Years)

Preferred skills:
Trauma, CMS HCC, VBP P4P programs, risk adjustment, PSIs.


CA RN license

Description:


Number of years of experience: Minimum 3 year CDS experience
minimum of 1 year of Clinical Documentation Specialist experience
All other experience does not count.. UM, clinical, nursing or coding.. has to be specific to Clinical Documentation.


Preferred skills: N/A
Required Minimum Qualifications
Licensure: RN License in US (does not require CA RN license), Foreign Medical Physician
Education: Associate, bachelor
Certification: CCDS, CCS Preferred
Experience: -Power Chart (Cerner)
-3M 360
-Midas
-Proficient in APR and MS DRG methodology
-Experience in denials related to DRG downgrades
-Able to review denials, create and submit appeal letters
-Clinical Documentation/Coding knowledge in Trauma, NICU, Obstetric Service lines strongly preferred
-HCC Knowledge and other risk adjustment methodologies (i.e. Vizient, Elixhauser)
-PSI/HAC


Number of years of experience: Minimum 3 year CDS experience
minimum of 1 year of Clinical Documentation Specialist experience
All other experience does not count.. UM, clinical, nursing or coding.. has to be specific to Clinical Documentation.

Summary of Major Function
The Clinical Documentation and Coding Integrity Quality Auditor performs clinical documentation validation reviews. Performs quantitative and qualitative reviews and analysis of the clinical health records and physician queries both concurrently and retrospectively to ensure documentation is accurate, consistent and complete. Quality Auditor identifies educational opportunities, including discrepancies in clinical indicators and diagnostic statements which impact DRG assignment, severity of illness, risk of mortality and resource utilization. Quality Auditor is also involved in the clinical denial/appeal process for DRG challenges and clinical validations of both external and internal claims. The Quality Auditor utilizes analysis of data, dashboards, and audits to assist in
identifying gaps, root causes and solutions for clinical documentation specialists and physician leadership. The Quality Auditor acts as a subject matter expert and resource for the Clinical Documentation Specialists and assumes the role of CDS as demands for services requires. May perform other duties as assigned.