RN Specialist, Clinical Documentation (denverhealth)

Job Description

We are recruiting for a motivated RN Specialist, Clinical Documentation to join our team!

We are here for life’s journey.
Where is your life journey taking you?

Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:

Humanity in action, Triumph in hardship, Transformation in health.

Department

Revenue Cycle Administration

Job Summary

Under general supervision performs concurrent and retrospective reviews as requested by the Revenue Integrity   Director. Responsible for selected assignments based on internal or external department requests. Responsible for clinical denial review, drafting appeals, tracking data trends and root cause analysis. Responsible for revenue integrity review to identify of documentation and operational processes to minimize lost charges and denials. Responsible for supporting education to varied audiences. Collaborates with Revenue Cycle Billing, Utilization Management, Physician Advisors, Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate and compliant billing practices as supported by the clinical documentation. Must participate in continuous education on ICD-10, medical necessity, 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%)
• Consolidating trends and tracking denial outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (15%)
• Educating providers , coding, CDI, UM, Revenue Cycle, and other ancillary departments regarding documentation accuracy, specificity, and compliance with rules and regulations. (10%)
• 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
• Bachelor’s Degree Preferred

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
• View Orignal JOB on: nursingjobs.site
  Certification in Clinical Documentation Integrity, Coding, Utilization Management, Care Management, Auditing, Revenue Integrity, Revenue Cycle or Compliance Preferred

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

Days (United States of America)

Work Type

Fixed Term (Fixed Term)

Salary

$77,300.00 - $119,800.00 / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program 

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.