Clinical Validation Specialist - Full-time

Under the supervision of the Manager of Coding and Clinical Documentation Improvement, the Clinical Validation Specialist is responsible for improving the overall quality and completeness of clinical documentation; facilitates and obtains appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risks of mortality, and complexity of care of the patient. Utilizes both clinical and coding knowledge to obtain appropriate documentation.

Education

Associates Degree preferred.

Experience

Minimum three (3) years’ experience in inpatient coding or other clinical disciplines with either coding or CDI experience or an equivalent combination of these disciplines.

Knowledge, Skills and Abilities

• Demonstrated knowledge of medical terminology and anatomy and physiology
• Knowledge of ICD-10 CM & PCS coding guidelines and APR-DRG assignment
• Analytic skills necessary to clinically review the electronic health record
• Basic computer skills in word processing and spreadsheet utilization
• Excellent interpersonal skills to develop relationships necessary to influence physician documentation processes
• Excellent prioritization and organizational skills

Licensures, Certifications

• Credential in Coding and Clinical Documentation Improvement strongly preferred; required to be obtained within a year of hire

Patient & Workplace Safety: 

• Employee has knowledge and understanding of patient and workforce safety as it relates to job duties. 

Patient Population: 

• Demonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable. 

Principal Duties and Responsibilities

•  Completes review of inpatient admissions to evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses and procedures for accurate DRG assignment, risk of mortality and severity of illness.
• Queries regarding missing, unclear, or conflicting EHR documentation by requesting and obtaining additional documentation within the EHR when needed. 
• Performs clinical validation of all diagnoses, abnormal laboratory data, abnormal radiology reports as well as applying internal clinical criteria to documentation. 
• Demonstrates knowledge of APR DRG logic (including Severity of Illness and Risk of Mortality), documentation opportunities, and clinical documentation requirements.
• Collects accurate data and reports demographic information to ensure the integrity of data use throughout the institution
• Conducts follow-up reviews of clinical documentation every 2-3 days and completes final coding upon patient discharge. 
• Strong clinical knowledge and demonstrated commitment to maintaining relevancy in clinical field.
• Maintains established productivity standards for all reviews and final coding.  
• Facilitates change processes required to capture needed documentation, such as documentation redesign.
• Educates physicians and key healthcare provider regarding clinical documentation improvement and the need for accurate and complete documentation in the health record.

 All roles must demonstrate GBMC Values:

Respect

I will treat everyone with courtesy. I will foster a healing environment.

• Treats others with fairness, kindness, and respect for personal dignity and privacy
• Listens and responds appropriately to others’ needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

• Meets and/or exceeds customer expectations
• Actively pursues learning and self-development
• Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

• Sets a positive, professional example for others
• Takes ownership of problems and does what is needed to solve them
• Appropriately plans and utilizes required resources for various job duties
• Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

• Works cooperatively and collaboratively with others for the success of the team
• Addresses and resolves conflict in a positive way
• Seeks out the ideas of others