Clinical Documentation Specialist (8078762)
American Cybersystems, Inc.

Job Info

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Innova Solutions is immediately hiring for a Clinical Documentation Specialist with at least 3 years experience

Position type: Full-time < Contract to Hire for right candidate.
Duration: 3 months+
Location: Remote

As a Clinical Documentation Specialist with you will:

• RHIA/RHIT/Cert. Coder (Associates Degree in HIM required; Bachelor's degree in HIM highly preferred) OR Registered Nurse (ADN required; BSN highly preferred)
• A minimum of 3 years of experience in area of population to be served is required
• 3 years pervious acute hospital inpatient coding experience highly preferred
• Current Texas and/or Louisiana RN license required for RN OR RHIT or Certified Coding Specialist required for HIM; RHIA preferred
• Certified Clinical Documentation Specialist (CCDS) highly preferred

Job Description/Additional Details:

• The PRN Clinical Documentation Specialist (CDS) position is responsible for facilitating improvement in the overall quality and completeness of the medical record documentation. The PRN CDS will provide support and expertise on a temporary basis through comprehensive assessment and review of inpatient medical records. The PRN CDS will facilitate accurate DRG assignment and obtain appropriate documentation through extensive interaction with physicians, patient caregivers and health information management coding staff to ensure that reimbursement (reflecting proper quality of care and appropriate reimbursement) is received for the level of services rendered to the patients.

Major Responsibilities:

• Performs concurrent and retrospective reviews of the medical record utilizing evidence-based knowledge, protocols and criteria.
• Works closely with the medical staff and other healthcare team member to help identify potential gaps in physician documentation and ensuring appropriate reimbursement is received for the level of service rendered to all patients.
• Utilizes research, analytic data and observations to provide recommendations to improve the overall quality and completeness of clinical documentation.
• Establishes cooperative and multidisciplinary relationships with physicians, coding staff and other health team members.
• Acts as a resource to the CDI department and health team members related to optimal documentation, educational needs and successful problem resolution.
• Demonstrates familiarity with MS-DRG/APR-DRG's and Inpatient Prospective Payment System (IPPS).
• Completes initial reviews of patient records to evaluate documentation to identify and assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate assignment of the working DRG, risk of mortality, and severity of illness.
• Completes follow-up reviews.
• Reviews a minimum of standard charts per day as directed.
• Analyzes clinical information. Formulates appropriate clinical documentation clarifications to improve documentation. Queries and educates physicians and key healthcare providers regarding clinical documentation improvement.
• In conjunction with CDI leadership, tracks response to clinical documentation and trends in CDI metrics.
• Maintains and enhances current medical, coding and CDI knowledge by participating in continuing education offerings.
• Consistently meets established productivity targets for record review.
• Assists in collection and organization of data for analysis by appropriate medical and hospital committees.
• Takes personal responsibility to ensure compliance with all policies, procedures and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.
• Performs all duties in a manner that protects the confidentiality of the patient and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.

Position Specific Competencies

• Strong clinical knowledge and understanding of pathology / physiology of disease processes.
• Excellent interpersonal skills to build excellent relationships with physicians, nurse, staff and to be able to educate them.
• Must work independently and manage goal productivity; must be efficient and accurate in performance.
• Working knowledge of MS-DRG and APR-DRG highly preferred.
• Must be familiar with the other functions in Medical Records and how they relate to the Coding function.
• Must be able to read and decipher handwriting that is difficult to read.

The ideal candidate will have: <Clinical Documentation>

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW.
Thank you!
Safaktullah Khan

PAY RANGE AND BENEFITS:
Pay Range*: $45-55 /hr
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS:Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

• One of Largest IT Consulting Staffing firms in the USA - Recognized as #4 by Staffing Industry Analysts (SIA 2022)
• ClearlyRated® Client Diamond Award Winner (2020)
• One of the Largest Certified MBE Companies in the NMSDC Network (2022)
• Advanced Tier Services partner with AWS and Gold with MS

Website: https://www.innovasolutions.com/

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.

This job has expired.