Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time
Works under the supervision of the Manager to complete basic to intermediate CDI reviews and re-reviews, submit queries to providers, complete first and second appeal levels. This position evaluates and partners with physician advisor on first and second level appeals, denial tracking. Rounding on patients, mortality reviews and second level reviews are also performed. Review and ICD-10-CM/PCS codes are assigned and appropriate DRG based on Official Coding Guidelines.
Responsibilities
- Conducts basic to intermediate initial, concurrent and retrospective reviews of clinical documentation for all selected admissions to initiate the tracking process and document findings. Abstracts data from concurrent and retrospective charts, as well as computerized data systems using documentation, Official Coding Guidelines and Official Query Guidelines.
- Assigns and updates ICD-10-CM/PCS codes and baseline and working MS-DRG and APR-DRG DRG for accounts, reviewing in a timely manner and documenting thoroughly in clinical documentation integrity system.
- Identifies need to clarify documentation in records and initiates communication with provider utilizing the appropriate query tools in order to capture the documentation in the medical record that accurately supports the patient’s severity of illness and risk of mortality.
- Reviews clinical validation denials and analyzes for appeal recommendation. Writes first and second level denial appeals in collaboration with physician advisor. Completes second level review including mortality reviews and quality reviews.
- Participates in staff training and departmental improvement activities and uses the results of the quality of quality audits to initiate change in practice. Communicates with coders to ensure that the correct DRG is assigned to each case; receives feedback as a means of continuous self-improvement
- Collaborates with other members of the interdisciplinary team to achieve accurate documentation for coding (example: rounds with physicians, attends team conference).
- Assumes responsibility for professional development by participating in educational opportunities via webinars, online education and online meetings.
- Achieves CDI quality and productivity goals.
- Other duties as assigned
Education
- Associate’s Degree – Nursing – Required
- Bachelor’s Degree – Nursing – Preferred
Work Experience
- 3 Years – Clinical experience in an ICU/Critical Care acute care setting – Required
- 1 Year – Experience in clinical documentation integrity functions – Preferred
Licenses and Certifications
- Registered Nurse (RN) – State Licensure/Or Compact State Licensure – State Licensure/Or Compact State Licensure in state, depending upon designated work location – Required Upon Hire
- Certified Clinical Documentation Specialist (CCDS) – Required within 2 Years Or
- Certified Documentation Improvement Practitioner (CDIP) – Required within 2 Years
