Posting Note: #PCHCB
This position facilitates modifications to clinical documentation through extensive concurrent interaction with physicians, nursing staff, other patient caregivers, and HIM coding staff to support that appropriate reimbursement and clinical severity is captured for the level of service rendered to all patients. This position reviews inpatient medical records while patients are still in-house for proper documentation; includes new admissions to the facility, as well as re-reviews periodically until the patient is discharged and is responsible for communication with clinicians and physicians to ensure timely and accurate documentation. This position provides training and education as needed. Individual will be responsible for the review of payer denials and participation in the appeal of clinical validation denials. This position receives regular supervision of work activities from the Mgr, Coding Compliance & CDI and does not provide direct supervision.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- Communicates with the individual physician or medical staff departments to facilitate complete and accurate documentation of the inpatient record.
- Facilitates modifications to clinical documentation supporting appropriate reimbursement is received for the level of service rendered to all patients with a DRG based payer.
- Initiates and performs concurrent documentation review of selected inpatient records to clarify conditions/diagnoses and procedures where inadequate or conflicting documentation exists.
- Assists the HIM department in facilitation of the physician query process.
- Performs focused reviews at the discretion of the Manager, IP Coding and CDI and HIM Director.
- Reviews the medical record and provides supporting documentation to assist with the appeal of payer clinical validation denials.
- Serves as a resource for physicians to help link ICD-10-CM coding guidelines and medical terminology to improve accuracy of final code assignment.
- Works in a collaborative fashion with the Health Information Management department in concurrently reviewing the inpatient medical record to assure correct provisional and final DRG assignment.
- Works in collaboration with HIM, Managers of Case Management and the Medical Director of Clinical Documentation Improvement/Utilization Management to analyze medical queries and the development of new physician queries.
- Identifies opportunities for interdepartmental operational improvements.
- Monitors, evaluates and reports concurrent coding outcomes at designated intervals to departments and committees.
- Cultivates and maintains effective interaction/communication with members of the medical staff, nursing staff, social workers, UR Team and peers.
- Maintains accurate records of review activities to comply with departmental and regulatory agency guidelines.
- Tracks and trends program compliance.
- Demonstrates knowledge of payer issues, documentation opportunities, clinical documentation requirements, and referral policies and procedures.
Provides excellent customer service
- Provides excellent service routinely in interactions with all customers, i.e. coworkers, patients, visitors, physicians, volunteers, etc.
- Responds to emails within 24 hours.
- Performs miscellaneous job related duties as requested.