Compliance Documentation Integrity Specialist

10169 Enterprise Corporate - Clinical Documentation ImprovementFull timeYes40

Fulltime, Dayshift Monday - Friday and this role will be hybrid with 2-3 onsite days at Atrium Health Pineville location,

Pay Range:

$38.20 - $57.30

Major Responsibilities:

• Reviews selected populations of inpatient medical records to identify the principal and/or secondary diagnoses. Appropriately assigns the MS-DRG that most accurately reflects the severity of illness of the patient based upon the clinical evidence documented at the time of the record review.
• Demonstrates knowledge and understanding of severity based DRG systems; All Patient Refined and Medicare Severity (AP-DRG) and Medical Severity Diagnostic Related Group System (MS-DRG).
• Demonstrates the ability to utilize the licensed software tool to perform and record daily medical record reviews.
• Interacts with the physician and/or other designated members of the healthcare team to ensure that vague or incomplete documentation is clarified within the medical record in a timely manner.
• Works with other departments such as coding, corporate compliance, quality, and finance to support Corporate Goals.
• Participates in the ongoing education of physicians, nurse practitioners, physician assistants and other healthcare team members to identify medical record documentation improvement opportunities employing conflict resolution skills as necessary.
• Utilizes critical thinking skills based upon extensive knowledge of disease processes and clinical outcomes to identify the need for further clarification of physician documentation within the medical record.
• Ensures that all written requests to physicians for additional documentation support Corporate Compliance policies.

Licensure, Registration, and/or Certification Required:

• Registered Nurse applicable state Licensure required.
• Appropriate professional certification required within 3 years of hire date per department protocol.

Education Required:

• Bachelor's Degree Required.

Experience Required:

• Clinical experience within the assigned population.
• Extensive knowledge of disease processes and clinical outcomes.
• Case Management experience or background helpful.

Experience Preferred:

• 5 years of related nursing experience preferred.
• Strong financial and analytical skills preferred.
• Word, Outlook, Excel experience preferred.

Physical Requirements and Working Conditions:

• Works in an office type setting, extensive walking throughout the facility.
• Prolonged periods of sitting reviewing medical records and documentation.
• Repetitive wrist motion and occasional lifting of 10-20 pounds.
• Intact sight and hearing with or without assistive devices are required.
• Ability to speak English fluently and write in understandable terms.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.