Utilization Review Rn Jobs in Philadelphia, PA (NOW HIRING)

Position Summary

The  Documentation Review Nurse will apply expertise and knowledge and review clinical documentation of Emergency Department (ED) Records to ensure accuracy, completeness, and compliance with E&M Level coding and billing standards for reimbursement purposes.  This position will be reviewing the E&M Level coding and documentation of nurses. The position will support data integrity and will collaborate closely with physicians, coders, and other healthcare professionals to optimize documentation practices, improve the accuracy of coding and maximize reimbursements and minimize billing denials.

Primary Position Responsibilities

1. Clinical Documentation Review:  Assess emergency department documentation using Emergency Department E/M and Critical Care Facility Charge Assessment tool to ensure the patient documentation accurately reflects the patient’s clinical presentation, diagnoses, and captures all treatment and services provided. 
2. Coding Compliance:  Verify that documentation support  CPT,  E&M Level and HCPCS codes for billing and reimbursement.
3. Education and Feedback:  Provide constructive feedback and education to ED nursing team on documentation practices to improve compliance and clarity.
4. Collaboration with Coders:  Work closely with coding professionals to address discrepancies and clarify documentation for accurate coding.
5. Regulatory Compliance:  Ensure all documentation aligns with regulatory requirements, payor policies, and industry standards.
6. Performance Metrics:  Track and report on nursing documentation trends, identifying areas for improvement to enhance reimbursement and reduce denials.
7. Continuous Learning:  Stay up to date on changes in E&M coding guidelines, payor requirements, and clinical documentation standards.
8. HIPAA Compliance:  Maintain strict HIPAA compliance and confidentiality in reference to all information reviewed and/or discussed.
9. Utilize effective critical thinking skills to resolve issues and assess and implement improved methods for efficient capture of patient services in compliance with coding and documentation regulations to ensure revenue capture and reduce denials and appeals. 
10. Work closely with 3rd party vendors, IT, and internal revenue cycle teams to resolve data quality issues 
11. Other duties as assigned:  to support the unit, department, entity and health system.

Qualifications

Minimum Education:

Required:

Registered Nurse (RN) with an active and unencumbered license

Preferred:

 Bachelor of Science in Nursing (BSN) preferred

Minimum Years of Experience (Amount, Type and Variation):

Required:

Minimum of three (3) years clinical nursing experience

Preferred:

 Previous nursing experience in an emergency department

License, Registry or Certification:

Required:

RN certification

Preferred:

None

Knowledge, Skills and/or Abilities:

Required:

• Strong understanding of ICD-10, CPT and HCPCS coding principles
• Knowledge of Medicare reimbursement and coding structures/systems

Preferred:

• Experience in clinical documentation improvement (CDI), coding or utilization review is highly desirable/preferred
• Excellent analytical, organizational and communication skills
• Proficient in electronic health records (EHRs) and clinical documentation systems
• High level creativity, judgment and initiative, tempered with flexibility to deal with rapidly changing healthcare environment and expanding technology
• Ability to maintain concentration with attention to detail even in areas containing multiple levels of distraction
• Self-motivated, well organized and possess confidence and ability to wor work independently and deal with ambiguity and ask critical questions to problem solve issues as required.

Hunterdon Health is committed to providing a competitive benefit package to our employees.  Benefit offerings vary based on status and may include but not be limited to medical, dental, vision, family forming, paid time off, tuition reimbursement, and retirement savings

The hiring range listed is the potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement. When determining an applicant’s hourly rate and/or base salary, several factors may be considered as applicable (e.g., years of relevant experience, education, internal equity, and specialty).