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

• Required. Registered Nurse (RN) - State of Michigan Upon Hire Or Nurse Practitioner (NP) - State of Michigan Upon Hire OrPhysician Assistant - State of Michigan

• Required. Clinical Documentation Specialist, Certified (CCDS) - CCAP Department within 2 years

• Required. 5 years of relevant experience in a clinical role

• Preferred. Master's Degree Health Related Field

• Preferred. Clinical Documentation Review experience

Primary Location

Department Name

Employment Type

Shift

Weekly Scheduled Hours

Hours of Work

Days Worked

Weekend Frequency

CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.

Spectrum Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment.

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.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws.