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Ensemble Health Partners

End-to-end revenue cycle management for hospitals

RN Clinical Documentation Specialist - Referrals

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timePutnam, CT, USA

About the Job

Requirements

  • Minimum of five years of acute care nursing experience, specifically in medical/surgical, Intensive Care, or Emergency Department settings.
  • Current RN licensure.
  • CRCR certification is required within nine months of hire.
  • Strong interpersonal skills, including verbal and written communication skills and proficiency in physician relations.
  • Ability to organize and present information clearly and concisely.
  • Excellent computer and keyboarding skills and strong prioritization skills.
  • Inquisitiveness and openness to innovation, including AI, to explore better processes and improve patient and client experiences.

Responsibilities

  • Complete an initial patient medical record review within 24–48 hours of admission, perform subsequent reviews every 24–48 hours, and enter findings in the CDE software system.
  • Assign principal diagnoses and CC/MCC; evaluate severity of illness and risk of mortality for all in-house patients; assign working ICD-10-CM and PCS codes and DRGs using the encoder in the CDE software.
  • Clarify missing, unclear, unsupported, or conflicting health record documentation with physicians by requesting additional documentation when needed, using face-to-face interaction and written clarifications.
  • Educate physicians, nurse practitioners, allied health professionals, nursing staff, and care coordination staff on clinical documentation improvement, documentation guidelines, and the need for accurate and complete health records.
  • Partner with coding professionals to ensure diagnostic and procedural data accuracy and supporting documentation completeness for working and final DRG assignments; review DRG denial letters and write denial appeal letters.
  • Collaborate with care coordination, nursing, and ancillary staff regarding physician documentation interactions and resolution of clarifications before patient discharge.
  • Maintain and uphold clinical documentation regulatory guidelines.
  • Submit timely, prepared appeals for reconsideration by third-party administrators, supported by clinical evidence, Coding/CDE Guidelines, and applicable regulatory standards and guidelines.
  • Collaborate with coworkers and management to resolve root-cause issues affecting payor contracts, hospital operations, or departmental operations, and to maintain reimbursement and minimize appeal requests or denials.

About the Company

Ensemble Health Partners

End-to-end revenue cycle management for hospitals

Ensemble Health Partners provides end-to-end revenue cycle management for hospitals and health systems. It handles the entire process from patient intake to final payment, with teams and technology embedded into the provider's operations and a revenue model tied to performance improvements. The company uses its proprietary EIQ platform (analytics, AI, and workflow automation) to optimize revenue cycle processes, reduce insurance denials, and speed cash collection, managing more than $39 billion in net patient revenue. Its approach differentiates it by being a true managed-services partner with full accountability for financial outcomes and a track record of meeting initial client goals. The overarching goal is to improve healthcare providers’ financial performance so they can focus on patient care.

Company size
5,001-10,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Cincinnati, OH
Founded
2014

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