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Job Description

Summary
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 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.

Qualifications

• Bachelor's Degree equivalent Nursing (for CCAP department); health care or other related field (for Denials department) Required
• Master's Degree health related field Preferred
• 5 years of relevant experience in a clinical role Required
• Experience in any one or more of the following areas: insurance, utilization review, case management, coding and/or clinical documentation review (Denials department only) Required
• NURSING\Registered Nurse (RN) Required Or
• NURSING\Licensed Practical Nurse in MI (LPN) Required
• NON CLINICAL\Clinical Documentation Specialist, Certified (CCDS) All unless otherwise noted Preferred
• NON CLINICAL\Clinical Documentation Specialist, Certified (CCDS) CCAP Department 2 Yrs Required

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Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member’s job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here.