RN Specialist, Clinical Documentation - Hybrid - Must live in Colorado

We are recruiting for a motivated RN Specialist, Clinical Documentation - Hybrid - Must live in Colorado to join our team!

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Department

Revenue Cycle Administration

Job Summary

Under general supervision performs concurrent and retrospective reviews as requested by the Revenue Integrity   Director. Responsible for selected assignments based on internal or external department requests. Responsible for clinical denial review, drafting appeals, tracking data trends and root cause analysis. Responsible for revenue integrity review to identify of documentation and operational processes to minimize lost charges and denials. Responsible for supporting education to varied audiences. Collaborates with Revenue Cycle Billing, Utilization Management, Physician Advisors, Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate and compliant billing practices as supported by the clinical documentation. Must participate in continuous education on ICD-10, medical necessity, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies.

Essential Functions:

• Concurrent and/or retrospective review of designated inpatient, outpatient, and ambulatory patient records to assess for accuracy, specificity, and compliance of patient status, charges, and billing. (25%)
• Reviewing & appealing clinical denials in accordance with current medical literature, CMS regulations and individual payer contracts, policies, or provider manuals. Consolidating trends and tracking outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership.(40%)
• Consolidating trends and tracking denial outcomes for routine Revenue Cycle reporting. Escalating findings to Revenue Cycle leadership. (15%)
• Educating providers, coding, CDI, UM, Revenue Cycle, and other ancillary departments regarding documentation accuracy, specificity, and compliance with rules and regulations. (10%)
• Working collaboratively with clinical and non-clinical departments across the organization to support process improvement and obtaining accurate and compliant billing practices (10%)

Education:

• Associate's Degree Required
• Bachelor’s Degree Preferred

Work Experience:

• 4-6 years of experience as a nurse in a hospital environment Required and
• 4-6 years with the appropriate level of experience in one or a combination of the following medical documentation related function: clinical coding, case management, DRG coordination, physician education, Medicaid/Medicare reimbursement. Required

Licenses:

• RN-Registered Nurse - DORA - Department of Regulatory Agencies Required
• Certification in Clinical Documentation Integrity, Coding, Utilization Management, Care Management, Auditing, Revenue Integrity, Revenue Cycle or Compliance Preferred

Knowledge, Skills and Abilities:

• Communicate effectively in written and verbal means to ensure ideas are clearly and professionally expressed and to support respectful interdepartmental collaboration.
• Demonstrates knowledge of clinical documentation, coding systems utilized for facility and professional services in all care settings (ie: ICD-10-CM, ICD-10-PCS, CPT/HCPCS), Coding Guidelines, DRG assignments, Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Charge Description Masters (CDM), Centers for Medicaid & Medicare Services (CMS) rules & regulations.
• Demonstrates knowledge of medical necessity criteria and billing requirements for establishing the correct Inpatient, Observation, Outpatient patient status in accordance with CMS and payor contracts, policies, and provider manuals. 
• Demonstrates knowledge of insurance terms, hospital billing, and professional billing terms and payment methodologies. 
• Must be able to communicate and interact tactfully with physicians and other professionals by expressing ideas clearly and concisely and addressing audiences effectively.
• Ability to read and interpret professional journals, financial reports, and legal documents as necessary.
• Ability to define