Signed in as:
filler@godaddy.com
Signed in as:
filler@godaddy.com
Responsible for preparing statistical reports, coding diseases and operations according to accepted classification systems and maintaining indices according to established policies and procedures.
D.O.E.
Provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services. The goal of concurrent review includes facilitation of appropriate physician documentation of care delivered to accurately reflect patient severity of illness and risk of mortality.
Specific reviews are both determined internally and by requirements/requests of external payers or regulatory agencies and play a significant role in reporting quality of care outcomes and in obtaining accurate and compliant reimbursement for acute care services.
Description/Purpose of Position: Provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services.
The goal of concurrent review includes facilitation of appropriate physician documentation of care delivered to accurately reflect patient severity of illness and risk of mortality.
Specific reviews are both determined internally and by requirements/requests of external payers or regulatory agencies and play a significant role in reporting quality of care outcomes and in obtaining accurate and compliant reimbursement for acute care services.
Minimum QualificationsEducation: Associates or Bachelor’s Degree in Nursing or Health Information Management
Experience: Minimum of five (5) years of clinical experience in an acute care setting critical care, medical/surgical or Emergency Department nursing preferred. Or, minimum of five (5) years of coding experience in an acute care setting.
Technical Skills: Computer proficiency to include word processing, databases, and spreadsheets. Familiarity with the operation of basic office equipment.
License/Certification: Current RN license in the State of Nevada, or licensed RHIT or RHIA with CCS credential.
Other: Knowledge of age-specific needs and elements of disease processes and related procedures required. Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes.
Working knowledge of inpatient admission criteria, Medicare reimbursement system and coding systems preferred, but not required. Must possess excellent written and verbal communication skills and critical thinking skills. Ability to work independently in a time oriented environment is essential.
$80,000 - $110,000
Facilitates the improvement in the overall quality and completeness of concurrent medical record documentation to help achieve accurate inpatient coding,
APR-DGR assignment, severity level and reimbursement. Obtains appropriate documentation through interactions with physicians and staff. Educates members of the patient care team on documentation guidelines.
COMPENTENCIES
Education: Requires either successful completion of a RN program, successful completion of an AMA approved Physician Assistant program or successful completion of the academic requirements, at the baccalaureate level (RHIA), of an HIM program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).Knowledge:
Requires excellent and comprehensive knowledge of anatomy, physiology, as defined by the Medical Diagnostic Categories and all body systems. Strong background knowledge of disease process, pharmacology.
Requires college-level knowledge of Medical Terminology.
Requires a complete and thorough understanding of the unique functions of each clinical area. Must be conversent in: ICD-9-CM, APRDRGs, DRGs Must be proficient with Microsoft Word, Excel, and Power Point.
Knowledge of Access, knowledge of other programming languages a plus. Requires in-depth knowledge of clinical coding processing and documentation standards, guidelines, policies and procedures.
Must be conversant in clinical documentation improvement. High level of proficiency in adult education and training Requires a thorough understanding of Hospital bylaws and Joint Commission standards related to departmental activities.
Requires knowledge of clinical pertinence requirements and proficiency in abstraction and data entry into all of the data base systems used for clinical documentation. Must be able to read and interpret electronic and manual documentation generated by healthcare professionals.
Requires understanding of HSCRC and CMI impact on hospital budget.Skills: Strong interpersonal, communication (verbal, non-verbal, and listening) skills. Experience in developing and presenting education programs. An understanding of adult learning theory and instructional design. Competent computer skills including word processing, spreadsheets, presentation software.
Analytical skills.
Required Licensure Certification: RN: Must possess current licensure to practice as RN in State of Maryland or another state that participates in the Nurse Licensure Compact. PA:
Must possess current licensure to practice as a PA by the Maryland Board of Physicians. Board certified by the National Commission on Certification of Physician Assistants (NCCPA). RHIA: Must possess certification through the Association of Clinical Documentation Improvement Specialists (ACDIS) or be a Certified Coding Specialist (CCS).
Work Experience: RN : Requires a minimum of 3 years registered nurse clinical experience in similarly complex acute care setting. Familiarity with utilization review, case management, nurse review activities or coding experience preferred. PA:
Requires a minimum of 3 years as a Physician’s Assistant in a similarly complex acute care setting. RHIA: Requires minimum 3 years of previous APR-DRG validation experience and 5 years of coding and clinical documentation experience with extensive clinical knowledge in an acute hospital environment.
$80,000 - $105,000