Clinical Document Specialist Senior

About the role

Conducts thorough analysis encompassing clinical review and assessment of patient records focusing on the documentation of the clinical condition and the care provided. Ensures that the level of patient services provided is accurately and completely documented. Develops, communicates, and implements solutions/programs to address problem areas identified through quality studies or claim denials, working directly with physicians and other health care professionals.

Responsibilities

• Promotes proper and ethical documentation and coding/billing activities to improve the organization’s level of accurate reimbursement.
• Conducts in-depth analysis of documentation of clinical care rendered in inpatient and outpatient settings.
• Uses critical analysis to determine appropriate DRG or coding assignment, appropriate setting, medical necessity, coverage of experimental services, and clinically related visits.
• Ensures services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
• Prepares detailed clinical summaries and/or other clinical documentation as necessary.
• Analyzes current practices in patient care, documentation, and coding/billing using observation and data/statistical analysis to identify areas of opportunity.
• Develops and communicates recommended solutions/programs to address problem areas to physicians and other health care professionals.
• Communicates study findings and trains physicians and other healthcare professionals on current data and healthcare trends related to appropriate clinical documentation and evidence-based medicine.
• Utilizes project management skills to identify project scope, requirements, decision points, timelines, and resource needs for planning, prioritization, implementation, and evaluation of complex, multifaceted quality and patient safety projects.
• Aids in continuous monitoring of data for quality, cost-effectiveness, and efficiency.
• Engages in process and quality improvement activities.
• Maintains professional competence, knowledge, and skills through continuous study of the field, including best practices.
• Completes required continuous training and education, including department-specific requirements.
• Ensures required documentation for activities within areas of responsibility is performed accurately and timely.

Requirements

• Bachelor’s degree in nursing, health-related field, or business administration.
• 5 years of relevant experience in a clinical role.
• Current licensure as one of the following in the State of Michigan:
  • Registered Nurse (RN)
  • Nurse Practitioner (NP)
  • Physician Assistant
• Certified Clinical Documentation Specialist (CCDS) certification (CRT-Clinical Documentation Specialist, Certified - CCAP).
• 2 years of experience in the department.

Preferred Qualifications

• Master’s degree in a health-related field.
• Clinical Documentation Review experience.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members, and communities. We are committed to cultivating and investing in you. Our top-notch teams are comprised of collaborators, leaders, and innovators that continue to build on one shared mission statement—to improve health, instill humanity, and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Benefits

• Comprehensive benefits package to meet financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory with deals on restaurants, phone plans, spas, and more.
• Optional identity theft protection, home, and auto insurance.
• Traditional and Roth retirement options with service contribution and match savings.

Schedule

• Full-time.
• Day shift (8:00 a.m. - 5:00 p.m.).
• 40 hours per week.
• Monday - Friday.
• No weekend work required.

Primary Location: 1810 Wealthy St SE, Grand Rapids, MI.