Clinical Documentation Quality Improvement Specialist III-Mt Sinai Hospital- FT Remote

About the role

The Clinical Documentation Specialist III is a senior technician responsible for improving the overall quality and completeness of clinical documentation, and proficient in all three grouper systems. Expert knowledge of ICD-10 CM/PCS and all current regulations is required.

Responsibilities

• Proficient in all (3) grouper systems, facilitates improvement in the overall quality, completeness and accuracy of medical record documentation through concurrent auditing and evaluation of the medical records.
• Facilitates modification of clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a Diagnosis-Related Group (DRG) payer under Medicare.
• Analyzes clinical status of patient, current treatment plan and past medical history to identify potential gaps in clinical documentation.
• Aids in the medical screening process, making referrals, interacting with case managers and clinical nurse specialists to ensure continuity of patient care as needed.
• Updates the DRG worksheet to monitor any changes in status, procedures/treatments, and confers with physicians to finalize diagnoses.
• Proactively solicits clarification from physicians to ensure points of clarification have been recorded in the patients chart.
• Maintains compliance with State and Federal payer regulations by monitoring activities related to clinical documentation.
• Reviews clinical issues with coding staff to assign a working DRG.
• Trains nursing staff, patient caregivers and coding staff on compliant documentation opportunities, coding and reimbursement issues as well as provides clinical expertise to the coding staff.
• Takes a lead role in education and mentoring less senior staff.
• Performs other related duties as assigned.

Qualifications

• RN/BSN or related health care professional preferred, with experience in med-surgical, critical care or emergency care a plus.
• Eligible for CAC, CCS or CCDS certification.
• At least 5 years of experience as a health care professional, with greater experience preferred, particularly in med-surgical, critical care or emergency care.
• Knowledge of ICD-10 CM/PCS and current Medicare and Medicaid regulations regarding clinical documentation and billing compliance for Part A and B services.