Quality Documentation Reviewer

company

Our client is a Hospital & Healthcare Company who partners with nephrologists to transform kidney care and improve patient outcomes. They believe that patients living with kidney disease deserve the best care and they are passionate about making an impact. When nephrologists are empowered, they are enabled to transform kidney care for their patients and partner with their patients on earlier identification of alternative modalities, slowing of disease progression, improved clinical outcomes, and increased quality of life.

qualifications

• High School/GED
• Valid Registered Nurse (RN)
• Auditing (1+ years)
• Clinical Practice (3+ years)

overview

Who You Are You are looking for an senior-level position and are interested in working with a Nashville-based entrepreneurial firm focused on building and growing transformational companies. You have a strong desire to lend your clinical knowledge, passion for creating training programs, and attention to documentation details to up and coming companies that will make a major impact in healthcare. You thrive in innovative and evolving environments with high rates of change. You are driven by process-improvements. Does this sound like you? If so, we should talk. Who We Are Our company partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care and we are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today. Your Role As a Quality Documentation Reviewer, you will partner with physician offices, vendors and APP's within our established partnerships to assess the health information that includes improving clinical documentation, quality measures, and regulatory guidelines. Quality Documentation Reviewer will work in collaboration with Medical Coder as appropriate. You serve as a subject matter expert in clinical documentation, quality measures, and regulatory guidelines. Essential Responsibilities: Work collaboratively with physicians, Advanced Practice Nurse Practitioners, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes, and quality is captured for the level of service rendered to all patients. -Audit clinical documentation and coded data to validate documentation supports diagnoses, procedures, and treatment and identifies deficiencies of evidence-based practice. Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future documentation discrepancies. RN CDEO professionals provide feedback to Clinical Quality Documentation Reviewer to improve clinical documentation and facilitate ongoing documentation improvement to meet all requirements of the medical record. Serves as a resource for documentation improvement. Apply critical thinking and decision-making skills to determine if the medical record documentation supports the need for service while maintaining production goals and quality standards. Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback, and education. Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. Actively demonstrates the organization’s mission and core values and conducts oneself at all times in a manner consistent with these values. Knows and adheres to all laws and regulations pertaining to patient health, safety, and medical information. Basic Qualifications: - You reviewed the Who You Are section of this job posting and immediately felt the need to read on. That makes you a match for our innovative culture. - Current RN License is required, plus CDEO or CDIP certification. - CMS HCC Risk Adjustment experience. - 1+ years of auditing experience. - 3+ years of clinical practice in a hospital, home care, or nursing home setting. - Demonstrated experience in reviewing clinical documentation, chart audits. - Demonstrates an understanding of current Quality Measure Initiatives including Value Based Care. - Demonstrates knowledge of pathophysiology, disease management, and coding guidelines. - Working knowledge of HIPAA Privacy and Security Rules. - You accept that things change quickly and are willing to pivot quickly on priorities. - Experience with EMR systems such as EPIC, Meditech, Cerner, Allscripts, Acumen. - Demonstrated proficiency in computer skills, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, Microsoft Teams. - Strong people skills and ability to build supportive relationships with providers. - Outstanding organizational skills and an ability to operate efficiently and independently. - A sound knowledge of medical coding guidelines and regulations, including compliance and reimbursement. This allows for a clear understanding of the impact of coding on payment models. - A thorough understanding of anatomy, pathophysiology, and medical terminology necessary to correctly code using CPT®, ICD-10-CM, and HCPCS Level II coding systems. How You are Supported You will benefit from our company’s exceptional total rewards package, including: - Competitive base pay with bonuses - Paid time off starting at 4 weeks for full time employees - 11 paid holidays per year, reimbursement for continuing medical education - 401k with match (coming soon) - health, dental, and vision insurance - Family friendly policies that support paid parental leave and flexible work arrangements. As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career. You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of our company’s high-quality, value-based, care model