Job Description
Under the direction of the Director of Case Management, facilitate improvement in the overall quality, completeness and accuracy of medical record documentation for the purposes of ensuring compliance with Medicare and Medicaid (CMS) regulations and guidelines and to expedite appropriate reimbursement.Collaborate with the Director of Health Information and the Medical Director to be successful in this role.Utilize both clinical and coding knowledge to obtain appropriate documentation through extensive interaction with physicians, nursing, other patient caregivers and Health Information Management staff.Educate all members of the patient care team on documentation guidelines on an ongoing basis.
- Inpatient medical records are reviewed on admission and throughout hospitalization per established guidelines.
- Clinical documentation is reviewed to ensure it reflects the level of service rendered to patients.
- Concurrent medical record review is managed and physician consultation is provided to achieve clinical documentation improvement goals.
- Diagnosis/DRG specific queries are written to identify inconsistent, conflicting and ambiguous documentation that need to be addressed.
- Physician education and consultation is provided to support consistent and specific documentation that meets regulatory requirements.
- Clinical documentation is reviewed to ensure that the intensity of services and level of acuity of the patient are accurately reflected in the medical record.
- Consultation is provided to coding staff, physicians and fiscal services to address payment denials, medical necessity and documentation issues to ensure compliance and optimal reimbursement.
- Medical necessity denials are audited to identify patterns of service and appeal opportunities.
- Policy and procedure changes are recommended to Utilization Review Committee to reduce denials and ensure documentation meets regulatory standards.
- Additional department, organization, or network activities are completed per established objectives.
- SRN Organizational Values of Innovation, Collaboration, Accountability, Respect, and Excellence are upheld
Qualifications Education/Degree Required
- Graduate of an accredited School of Nursing.
Experience Required
- Minimum of 5 years experience in either clinical nursing, case management, HIM inpatient coding or an equivalent combination of these disciplines.
Licensure Required
- Current licensure from the Massachusetts Board of Registration to practice professional nursing.
Skills (Specific learned activity gained through training (e.g. computer skills, keyboarding, presentation, CPR, ACLS, etc.)
Required
- Basic knowledge of coding/classification systems appropriate for inpatient DRG prospective payment system.
- Computer proficiency required.Microsoft office applications preferred with ability to learn new software.
- Ability to clearly present information in writing and in presentation form.
- Maintain variable work schedule to meet department needs. (evenings, holidays, weekends and travel).
Preferred
- Certificate in Case Management preferred.
- Knowledge of acute regulatory/accreditation requirements preferred.
- Highly developed communications and interpersonal skills, working with diverse population.
- Work independently, be self-directed and contribute as a member of a team.
- Anticipates challenges and develops and implements strategies for addressing them.
- High level of service delivery. Demonstrate initiative with ability to prioritize work, meet deadlines and adapt to changing situations.
- Attention to detail.
EEO Statement Spaulding Rehabilitation Network (SRN) is committed to diversity in the workplace which begins with respect and opportunity for all. SRN takes affirmative action to ensure that equal employment opportunity is provided to all persons regardless of race, religious creed, color, national origin, sex, sexual orientation, gender identity, genetic information, age, ancestry, veteran status, disability or any other basis that would be inconsistent with any applicable ordinance or law. If you need a reasonable accommodation in coming to or participating in the interview process, please let us know. Spaulding Hospital Cape Cod(SRN and SCC)
Job Tags
Holiday work, Weekend work, Afternoon shift,