RN Clinical Documentation Specialist - Referrals

O.N.E Purpose

Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement

The Base Salary for this role is $80,000

Job Responsibilities

• Completes initial patient medical record review within 24-48 hours of patient's admission; completes subsequent reviews of patient's medical record reviews every 24-48 hours and enters review findings in CDE software system
• Sets Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house
• Sets working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software
• Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record
• Pairs with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment
• Reviews DRG denial letters and writes denial appeal letters
• Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge
• Maintains and upholds all clinical documentation regulatory guidelines
• Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate
• Works collaboratively with co-workers and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials

Experience We Love

• Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
• Absolutely must have excellent computer and keyboarding skills; high degree of prioritization skills
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences

Minimum Education

• Current RN Licensure
• CRCR Required within 9 months of hire

Join An Award-winning Company

• Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution
• 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle
• 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment
• 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance
• 2020, 2022-2023 Energage Top Workplaces USA
• 2022-2024 Fortune Media Best Workplaces in Healthcare
• 2024 Monster Top Workplace for Remote Work
• 2024 Great Place to Work certified

Our Culture

• We believe in empowering people and giving them the tools and resources needed to thrive
• We put people first, last and always
• Our culture is rooted in collaboration, growth, and innovation

Growth

• We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement
• We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company

Innovation

• We provide reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law

Employment Disclaimers

• Ensemble is an equal employment opportunity employer
• We provide reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law