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Job Description

Job 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.

Essential Functions

• Works for the promotion of proper and ethical documentation and coding/billing activities, thus improving 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 that 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 for role.
• Analyzes current practices in the areas of patient care, documentation and coding/billing, utilizing 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 or other findings and trains physicians and other healthcare professionals as required in current data and healthcare trends as it relates to appropriate clinical documentation and evidenced-based medicine.
• Utilizing project management skills, identifies project scope, project requirements, decision points, timelines, and resource requirements for planning, prioritization, implementation, and evaluation of complex, multifaceted quality and patient safety decision support projects and programs.
• Aids in the continuous monitoring of data for quality, cost effectiveness and efficiency. Engages in process and quality improvement activities.
• Engages in continuous study of the entire professional field, including best practices, to maintain the professional competence, knowledge, and skills necessary for the satisfactory performance of all assigned responsibilities. Completes required continuous training and education, including department specific requirements.
• Ensures that required documentation for activities within areas of responsibility is performed in an accurate and timely manner.

Qualifications

• Required Bachelor's Degree Nursing, Health Related Field or Business Administration
• Preferred Master's Degree Health Related Field

• 5 years of relevant experience Clinical Role Required
• Clinical Documentation Review Preferred

• LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required Or
• LIC-Nurse Practitioner (NP) - STATE_MI State of Michigan Upon Hire required
• CRT-Clinical Documentation Specialist, Certified (CCDS) - UNKNOWN Unknown CCAP Department 2 Yrs required
• LIC-Physician Assistant - STATE_MI State of Michigan

Primary Location

SITE - Musculoskeletal Center - 230 Michigan St - Grand Rapids

Department Name

CDI Risk Adjustment

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 4:30 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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.