Role Description
The Professional Fee Clinical Documentation Specialist (CDS) will serve as an advisor and expert resource for providers to improve the accuracy of clinical documentation to support patient complexity, risk profiles and appropriate E/M levels thereby supporting the provider's efforts and their professional fee billing. The CDS primarily assists providers in identifying clinically relevant information and capturing the clinical documentation needed to accurately reflect patient acuity.
• Focus on the recapture and identification of chronic conditions reflected in Hierarchical Condition Categories (HCCs).
• Assist with highlighting opportunities based on the provider's medical decision making to appropriately reflect the level of service provided for patient care.
• Responsible for completing pre-visit and post-claim reviews.
• Provide clear communication and education to providers on their documentation, coding and billing practices, in adherence to compliance standards set by governing entities such as CMS, AHA, etc.
• Pre-visit reviews are intended to identify documentation opportunities for the provider to recapture previously documented HCCs diagnoses, or new suspect conditions.
• Post-claim reviews focus on E/M encounters and highlight opportunities based on a provider's medical decision making and the patient's acuity.
• Coordinate with colleagues from the CDI Program or other members of the organization regarding education and training geared towards improving clinical documentation.
Qualifications
• High School Equivalent / GED (Required)
• Associate's Degree (Preferred)
Requirements
• 3+ years Coding and/or clinical documentation integrity (Required)
• Extensive clinical knowledge and understanding of pathophysiology (Required proficiency)
• Strong critical thinking skills and utilization of clinical knowledge to identify potential clinical indicators supporting patient acuity (Required proficiency)
• Excellent written and verbal communication skills (Required proficiency)
• Strong project management skills (Required proficiency)
• Strong interpersonal skills, with demonstrated success at communicating effectively with all levels of the organization (Required proficiency)
• Ability to work independently in a time-oriented environment (Required proficiency)
• Demonstrates skilled ability and comfort with electronic medical records (EPIC preferred) (Required proficiency)
• Proficient with personal computer applications (Excel, Word, and Power Point) (Required proficiency)
• Ability to build education material that is meaningful for providers and team members (Required proficiency)
• Strong problem solving and investigative skills (Required proficiency)
Licenses and Certifications
• Certified Coding Specialist (CCS) (Required) or Certified Professional Coder (CPC) or CRC, or other coding or CDI credential (Required)
• Registered Nurse (RN), Ohio and/or Multi State Compact License (Preferred)
• Licensed Practical Nurse (LPN), Ohio and/or Multi State Compact License (Preferred)
Physical Demands
• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently
Travel Requirements
• 10%25