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Ascension · 1 day ago

Specialist-Clin Documentation

United States

Full-time

Remote

Entry, Mid Level

$75K/yr - $105K/yr

2+ years exp

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates. They are seeking a Specialist in Clinical Documentation to facilitate improvement in the quality, completeness, and accuracy of medical record documentation, and to collaborate with healthcare professionals to ensure accurate reflection of the severity of illness in medical records.

CharityHealth CareHospitalNon Profit

No H1B

Responsibilities

Facilitate improvement in overall quality, completeness and accuracy of medical record documentation

Complete admission reviews and assign a working Diagnosis Related Group. Ensure the working DRG and other information are entered in the Clinical Documentation Improvement database

Initiate and maintain extensive interactions with physicians and mid-level providers to address the need for more detailed information in the medical record

Collaborate with healthcare professionals to ensure the severity of illness and level of services provided are accurately reflected in the medical record and to resolve physician queries and documentation issues prior to patient's discharge

Maintain accurate records of review activities, ensuring reports and outcomes of CDI efforts are valid

Qualification

Certified Coding Specialist (CCS)Certified Professional Coder (CPC)Clinical Documentation Prof.Registered NurseReg Health Info AdmnstrCDI experienceOB/L&D experienceQuality project leadershipCollaboration skills

Required

One or more of the following required: Certified Coding Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or job transfer date

One or more of the following required: Certified Professional Coder (CPC) credentialed from the American Academy of Professional Coders (AAPC) obtained prior to hire date or job transfer date

One or more of the following required: Clinical Documentation Prof. credentialed from the Association of Clinical Documentation Improvement Specialists obtained prior to hire date or job transfer date

One or more of the following required: Registered Nurse credentialed from the Texas Board of Nursing obtained prior to hire date or job transfer date

One or more of the following required: Reg Health Info Admnstr credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or job transfer date

One or more of the following required: Reg Health Info Tech credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or job transfer date

High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required