Spec, Clinical Document Sr.

Job Summary

Conducts thorough analysis encompassing clinical review and assessment of patient records focusing on the documentation of the clinical condition and the care provided. Ensures that level of patient services provided is accurately and completely documented. Develops, communicates and implements solutions/programs to address problem areas identified through quality studies or claim denials working directly with physicians and other health care professionals.

Essential Functions

• Works for the promotion of proper and ethical documentation and coding/billing activities, thus improving the organization’s level of accurate reimbursement. Conducts in-depth analysis of documentation of clinical care rendered in inpatient and outpatient settings. Uses critical analysis to determine appropriate DRG or coding assignment, appropriate setting, medical necessity, coverage of experimental services, and clinically related visits. Ensures that services are provided in accordance with state and federal regulations, organizational policy and accreditation/compliance requirements.
• Prepares detailed clinical summaries and/or other clinical documentation as necessary for role.
• Analyzes current practices in the areas of patient care, documentation and coding/billing, utilizing observation and data/statistical analysis to identify areas of opportunity.
• Develops and communicates recommended solutions/programs to address problem areas to physicians and other health care professionals. Communicates study or other findings and trains physicians and other healthcare professionals as required in current data and healthcare trends as it relates to appropriate clinical documentation and evidenced-based medicine.
• Utilizing project management skills, identifies project scope, project requirements, decision points, timelines, and resource requirements for planning, prioritization, implementation, and evaluation of complex, multifaceted quality and patient safety decision support projects and programs.
• Aids in the continuous monitoring of data for quality, cost effectiveness and efficiency. Engages in process and quality improvement activities.
• Engages in continuous study of the entire professional field, including best practices, to maintain the professional competence, knowledge, and skills necessary for the satisfactory performance of all assigned responsibilities. Completes required continuous training and education, including department specific requirements.
• Ensures that required documentation for activities within areas of responsibility is performed in an accurate and timely manner.

Qualifications

Required

• Bachelor's degree nursing, Health Related Field or Business Administration

• 3 years of relevant experience Clinical Role Required

1 of 3 required

• LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required Or
• LIC-Nurse Practitioner (NP) - STATE_MI State of Michigan Upon Hire required Or
• LIC-Physician Assistant - STATE_MI State of Michigan Upon Hire required

Preferred

• Master's Degree Health Related Field
• Clinical Documentation Review

• CRT-Clinical Documentation Specialist, Certified (CCDS) - CCAP Department

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Corewell Health Place - 100 Corewell Drive NW - Grand Rapids

Department Name

Quality - CDI

Employment Type

Full time

Shift

Day (United States of America)