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Registered nurse (rn) clinical documentation specialist columbia


This is a Full-time position in Columbia, SC posted May 1, 2019.

Job Details Bachelors Degree Required Current South Carolina RN license required 2-4 years experience required Job : To perform on-site medical record reviews, examining and assessing all participant documentation to ensure that all information including the illness diagnosis is accurate.

Responsible for the validation of diagnosis codes and the identification of missing diagnosis so that participant severity of illness is properly reflected in the medical record and appropriate reimbursement is received.

All team members are responsible for bringing life to our Statement – Inspire health.

Serve with compassion.

Be the difference – through every action and every interaction at work.

: Facilitates appropriate clinical documentation to support diagnosis coding and ensure the level of service is recorded.

Works with medical providers to clarify clinical documentation in the participant’s medical record through a concurrent review process throughout the patient’s enrollment.

Requests clarification of clinical documentation from medical providers on a concurrent basis as needed to ensure documentation is complete and accurate.

Ensures the level of service rendered to patients, and the patient’s severity of illness is accurately documented and recorded.

Interacts with medical providers as needed to discuss and advise on clinical documentation requirements.

Provides timely and accurate responses to clinical documentation and coding questions.

Responsible for file maintenance including entry into database for tracking and trending audit results.

Communicate findings of potential or missed diagnoses and the revenue impact that were discovered during the chart audit.

Reviews as needed any clinical documentation issues with the medical staff to identify clinical documentation and coding opportunities; and to refine the concurrent review process.

Maintains clinical documentation that allows medical providers to accurately code principal and secondary diagnoses, capture complications and comorbidities and assign accurate HCC codes.

Reviews as needed any clinical issues with medical providers to identify those diagnoses that impact severity of illness indicators for each participant.

Follows up with required documentation that results in the accurate capture of the severity of illness and/or mortality.

Collaborates with medical providers to obtain documentation that most accureately reflects participant’s severity of illness.

Remain current on risk adjustment/HCC (Hierarchical Condition Category) methodologies to ensure focus on most relevant diagnoses.

Keep informed of changes to the risk adjustment HCC process and participate as needed in special projects relevant to risk adjustment changes.

: Education: Bachelor’s degree in Nursing from an accredited school of Nursing program that is approved by the South Carolina State Board of Nursing required.

Work experience may substitute for education requirement.

Experience: (3) Three years of Medical Coding experience required.

HCC coding experience preferred.

Licensure, Registry or Certification Required: RN currently licensed in South Carolina.

Requires one of the following certificates: RHIT, RHIA, CPC or CCSP, CCS.

Valid South Carolina driver’s license and an acceptable three-year motor vehicle record as defined by the Acceptable Motor Vehicle Record (MVR) Chart.

Supervisory : Provides recommendations, but does not make final decision in training.

Knowledge/Skills/Abilities: Must be able to perform keyboard operations and see the source document; must have problem solving abilities; good knowledge of anatomy, physiology, medical terminology, disease process, evaluation and treatment of geriatric patients; extensive working knowledge of ICD-10-CM coding.

EEO/AA Minorities/Females/Disabled/Veterans