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Denver Health

Public hospital system providing comprehensive care

RN Educator - Clinical Documentation Integrity

Corporate & Technical TrainingConfirmed live in the last 24 hours
Full-timeColorado, USA$85.6k - $132.6k /yr

About the Job

Requirements

  • A bachelor's degree in nursing or a related field is required, or an associate degree with an equivalent level of additional experience.
  • Seven to nine years of nursing experience, including at least two years in an acute care setting, are required.
  • One to three years of experience in clinical documentation integrity, clinical coding, diagnosis-related group coordination, or Medicare/Medicaid reimbursement is required; this experience may be included in the seven to nine years of nursing experience.
  • An active Registered Nurse license from the Colorado Department of Regulatory Agencies is required.
  • Knowledge of clinical criteria, pathophysiology, evidence-based practice, and current trends in medical treatment is required.
  • Ability to articulate clinical documentation requirements to physicians and other healthcare professionals is required.
  • Clinical expertise in urgent/emergent, medical/surgical, obstetrical, pediatric, and ambulatory care is required.
  • Ability to communicate complex ideas across groups, educate on areas needing improvement, translate between clinical and non-clinical teams, collaborate with diverse groups, and persuade and lead individuals or groups toward consensus is required.
  • Ability to read and interpret professional journals, financial reports, and legal documents is required.
  • Ability to define problems, collect and summarize data, establish facts, and draw conclusions is required.
  • Knowledge of Centers for Medicare & Medicaid Services Medicare and Medicaid, managed care and commercial health plan billing, reimbursement, and regulations is required.
  • Knowledge of value-based purchasing, bundled payments, accountable care organizations, readmission reduction programs, and public reporting of quality outcomes is required.
  • Critical thinking and the ability to autonomously prioritize work, manage time, and stay organized are required.
  • Knowledge of ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, Coding Clinics, and other references for coding accuracy and compliance is required.
  • Knowledge of quality measures, patient safety indicators, value-based purchasing, risk adjustments, mortality scoring, hospital-acquired conditions, CMS 5 Star, and external publicly reported quality metrics is required.
  • Knowledge of compliance practices, briefs, white papers, and other publications guiding ethical and legal practices of clinical documentation integrity is required.
  • Proficiency with multi-platform computer software and applications to track, analyze, calculate, and summarize data and qualitative findings is required, as is proficiency with the Microsoft suite.

Responsibilities

  • Perform complex clinical documentation reviews of designated inpatient, outpatient, and ambulatory patient records to assess provider documentation for accuracy, specificity, and compliance.
  • Draft and submit written queries to providers to obtain documentation clarification needed for accuracy, specificity, and compliance.
  • Develop and deliver a formalized clinical documentation integrity orientation process, using industry-endorsed content, adult learning methodologies, and subject matter expertise to train new team members.
  • Develop and perform an internal auditing process with the Clinical Documentation Integrity Manager to validate query compliance and identify educational opportunities for the continuing education plan.
  • Educate providers, coders, and the clinical documentation integrity team about clinical documentation concepts, health data, quality outcomes, and compliance regulations.
  • Partner with Revenue Integrity and Compliance teams to support appeals and education related to coding and documentation denials.
  • Inform new technology projects that affect clinical documentation integrity workflows, provider queries, and program outcomes.
  • Develop, facilitate, and coordinate organizational clinical documentation integrity education, including a formalized orientation curriculum and ongoing strategy to advance program outcomes.
  • As requested by the Clinical Documentation Integrity Manager, perform concurrent and retrospective reviews, quality reviews, internal compliance and performance audits, and support clinical review for new technologies and projects.
  • Educate providers on documentation specificity, accuracy, and compliance, and query physicians as necessary.
  • Collaborate with Coding, Health Information Management, Patient Safety and Quality, Enterprise Compliance Services, Revenue Integrity, and other departments to promote accurate documentation in patient records.

Desired Qualifications

  • One to three years of experience in education or supervisory work is preferred.
  • Clinical Documentation Integrity or coding certification is preferred.

About the Company

Denver Health

Public hospital system providing comprehensive care

Denver Health runs hospitals and clinics in Denver, providing emergency care, inpatient and outpatient services, and public health programs. Care is coordinated through primary care with referrals to specialists and hospital services within an integrated network that uses shared medical records. It stands out as a large, public safety-net system that serves uninsured and low-income patients and emphasizes care coordination across locations. Its goal is to ensure access to high-quality care for all residents, reduce health disparities, and improve the Denver community's overall health.

Company size
5,001-10,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Denver, CO
Founded
1860

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