The Clinical Documentation Improvement Specialist is responsible for reviewing and analyzing health records to identify relevant diagnoses and procedures for distinct patient encounters, provide feedback, and educate providers to improve documentation within the health record to accurately reflect patient care and adhere to reimbursement rules. Responsible for staying abreast of the continual changes in Federal and State regulations for prospective payment, keep informed of changes in treatment modes and new procedures, and to perform coding queries when physician documentation is vague or missing.
DUTIES AND RESPONSIBILITIES:
- Responsible for reviewing and researching billed unlisted procedure codes to determine if a more specific code exists and should be used.
- Responsible for effectively communicating with physicians in order to clarify diagnoses, procedures coding and documentation requirements.
- Responsible for translating diagnostic phrases utilized by healthcare providers into coded form.
- Responsible for helping clinicians on appropriate use of ICD-10 codes to maximize HEDIS performance incentives that are submitted through claims data.
- Responsible for monitoring all coding accuracy at various levels of detail and maintains coding quality as needed.
- Responsible for tracking coding issues and reviewing coding inaccuracies to highlight areas of improvement. Reports, then resolves or escalates issues as necessary.
- Responsible for performing a comprehensive medical records review to assure the presence of all components required to support the information submitted to payers.
- Responsible for providing a high level of technical proficiency and to serve as subject matter specialist regarding coding and documentation.
- Responsible for reviewing payment denials, underpayments, and payment take backs for appropriateness and produce resolution by adjustments.
- Responsible for actively participating in the Quality Management Program.
- Responsible for following all Agency safety and health standards, regulations, procedures, policies, and practices.
- Responsible for actively participating in the Management of the Environment of Care Program.
- The qualified candidate must possess a minimum of an A.S. Degree in the healthcare field preferably in Health Information Technology from an American Health Information Management Association (AHIMA) accredited college and one of the following certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) certification, Certified Coding Specialist (CCS), Clinical Documentation Improvement Practitioner (CDIP) or Certified Professional Coder (CPR).
- Excellent organizational, communication and customer service skills and the ability to utilize information Systems effectively (such as Microsoft Office Windows products, Outlook, etc.) is required
- Knowledge of information systems and healthcare applications.
- Strong understanding and knowledge of state, federal, and accreditation regulatory requirements: HIPAA Privacy, CMIA, The Joint Commission, and Managed Health Care Plans, etc.
- Demonstrate credibility with physicians and maintain productive and collaborative relationships with all clinical staff.
- Must be comfortable educating clinicians.
- Strong problem solving, group facilitation and teamwork skills.
- Ability to maintain patient confidentiality.
- Ability to work well with others in team oriented environment, work independently when needed, take initiative and use good judgment.
Arroyo Vista will consider qualified applicants with criminal histories.