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RN Clinical Documentation Improvement Specialist

AdventHealth • Full-time • Hinsdale, Illinois, United States • 5d ago

All the benefits and perks you need for you and your family:

Benefits from Day One for FT/PT positions
Paid Time Off from Day One for FT/PT positions
Transcribes documentation clarifications as appropriate for SOI, ROM, PSI, HCCs and HACs to ensure documentation compliance is accomplished.
Strategically educates members of the patient-care team regarding documentation regulations and guidelines, including physicians, allied health practitioners, nursing, and collaboration with the healthcare team. This includes quarterly and annual compliance updates from Medicare.
Effectively and appropriately communicates with physicians and other healthcare providers as necessary to ensure appropriate, accurate and complete clinical documentation. Communicates with HIM staff and collaborates with them to resolves discrepancies with DRG assignments and other coding issues.
Completes well-timed follow-up case reviews on all concurrent cases with priority given for resolution of those with clinical documentation clarifications.
Participates in department meetings, including feedback on outstanding issues, presentations for educational opportunities and any other needs identified by the CDI leaders.
Assumes personal responsibility for professional growth, development and continuing education to maintain a high level of proficiency.
Demonstrates competence in chart audits
Correctly identifies physician clarification opportunities
Proficient in formulating valid clarifications that are easily understood by physicians and other members of the medical team.
Accurately reconciles all cases in CDI database.
Maintains a 95% physician response rate to all valid clarifications.
Performs other duties as assigned.

Qualifications

The expertise and experiences you’ll need to succeed:

Knowledge And Skills Required

Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrates excellent physician relations.
Able to organize and present information clearly and concisely; excellent computer and keyboarding skills; ability to use multiple software programs simultaneously; high degree of prioritization skills.
Ability to learn/develop and fine-tune the skills necessary to perform optimally as a Clinical Documentation Specialist.
Dependable, self-motivated and pleasant.
Utilize and demonstrate excellent critical-thinking, problem-solving and deductive-reasoning skills.
Knowledge of pathophysiology, disease processes and treatments.
Strong ability to organize/triage work and manage multiple priorities at once.

Knowledge And Skills Preferred

Knowledge of clinical documentation requirements that identify clinical conditions or procedures.
Coding background.
Knowledge of quality guidelines.

Education And Experience Required

Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, post-acute care unit, or Emergency Department experience.
Minimum of one year of CDI experience

Education And Experience Preferred

BSN or higher
More than one year of Clinical Documentation Specialist experience

Licensure, Certification Or Registration Required

Current active State license as a Registered Nurse, Nurse Practitioner, Physician’s Assistant or an unlicensed physician who has graduated from a medical school that is listed in the World Directory of Medical Schools (World Directory) as meeting eligibility requirements for its graduates to apply to the Educational Commission for Foreign Medical Graduates (ECFMG) for ECFMG Certification and examination at the time of graduation.

Licensure, Certification Or Registration Preferred

CCDS (Certified Clinical Documentation Specialist) certification
CDIP (Certified Documentation Improvement Practitioner) certification

Required Competencies

AdventHealth online learning (ALN)
Achieve a 70% or greater on the AdventHealth Corporate Approved Pre-Hire Assessment
Achieve a 70% or greater on the Annual AdventHealth Corporate Approved Post-Hire Assessment

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical

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