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Position Details

Department: Coding - IP
Category: Hlth Info Mgmt/Med Records
Location: Phoenix
Posting #: 387323
Date Posted: 4/12/2018
Employee Type: Regular

Position Summary

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.

PCH Values

  • 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.

Position Duties

  1. Clinical Documentation
    • 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.
  2. Process improvement
    • 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.
  3. Regulatory
    • 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.
  4. 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.
  5. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Bachelors degree in Nursing or Associates degree in Nursing coupled with 3 years clinical experience or CCDS, CDIP, RHIA, RHIT, or CCS certification in lieu of ADN or BSN. Required
2. Masters degree in Nursing or Health Sciences. Preferred
Do you meet this requirement?
Experience
1. Minimum of (3) years of broad clinical experience, care coordination, case management, discharge planning, utilization review or acute care coding experience. Required
2. Working knowledge of the financial aspects of third party payers and reimbursement. Required
3. Experience in all areas of pediatric medicine inclusive of NICU and Behavioral Health Preferred
4. Milliman criteria knowledge Preferred
Do you meet this requirement?
Certifications/Licenses/Registries
1. Currently hold at least 1 role-related certification (AZ RN License or from a Compact state, CCDS, CDIP, RHIA, RHIT or CCS) Required
Do you meet this requirement?
Special Skills
1. Requires effective and positive human relations skills, including confidentiality, in order to appropriately interface with all levels of Phoenix Children's Hospital staff, physicians, patients and their families, and other contacts. Required
2. Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, influential leadership skill. Required
3. Demonstrated effective critical thinking skills Required
4. Moderate to expert computer skills Required
5. Excellent communication skills, both verbal and written Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Occasionally
2. Physical Requirement - Hearing Constantly
3. Physical Requirement - Pushing/pulling Occasionally
4. Physical Requirement - Reaching Occasionally
5. Physical Requirement - Sitting Constantly
6. Physical Requirement - Standing Occasionally
7. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
8. Physical Requirement - Talking Constantly
9. Physical Requirement - Walking Frequently
10. Physical Requirement - Near Vision Constantly
11. Physical Requirement - Far Vision Constantly
12. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
13. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
14. Occupational Exposure/Risk Potential - Inside office environment Applicable
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply