Quality Clinical Documentation Improvement RN
US-CA-RANCHO CORDOVA
commonspirit_careers
Req #: 408817
Type: Day
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Overview: Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. Responsibilities: ***This position is work from home within California. Position Summary: The Quality Clinical Documentation Improvement (QCDI) RN is responsible for performing a comprehensive review of ambulatory medical records to confirm documentation compliance with the Centers for Medicare and Medicaid Services (CMS) programs and other quality initiative programs Dignity Health Medical Foundation participates in. The primary focus of the QCDI RN position is to review provider documentation, provide education to providers, and review trends of assigned providers or medical groups. Additionally, the QCDI RN will provide guidance to Reimbursement staff in their day-to-day chart reviews. Responsibilities may include: - Reviews high volume of EMR medical records to determine if specific conditions were assessed and documented appropriately; Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures - Identifies claims correction opportunities and submit to appropriate personnel for processing in a timely manner within pre-set acceptable accuracy levels. Tracks trends for each physician to identify potential training areas. - Maintains accurate, timely tracking of physician documentation performance using established tools within the department; Alerts management when low performance trends occur. - Participates with third-party collaborator to identify trends and to address and resolve gaps in performance standards. - Provides chart review guidance and education to team regarding appropriate chart review methodology when necessary; Performs secondary chart reviews when applicable to clarify compliance to coding guidelines. - Provides assistance to team coordinator with annual spring training and annual one on one sessions, distribution of reports, reconciliation of quarterly and year end statistics, and other provider related activities. - Participates in training and orientation of staff. - Follows up with physicians and providers about missing or incomplete chart documentation via tasking and/or email. Provides guidance and education to assigned physicians for improved documentation performance. - Keeps manager informed of concerns in workflow, policy, or processes as it related to the organization's programs and interactions with physicians and clinic staff. Works collaboratively with team members to sustain a standard approach to chart reviews, accurate reporting, and performance tracking. - Mentors peers and promotes teamwork. - Participates in departmental or organizational committees and projects as assigned. Qualifications: Minimum Qualifications: - 3-5 years post licensure experience. - High School diploma or equivalent. Satisfactory completion of a formal Registered Nurse program pursuant to the Division of Allied Health Professions or military training that is equivalent to an accredited Registered Nurse program (determination by Dignity Health Medical Foundation HR department in conjunction with the State Division of Allied Health Professions). - Clear and current CA Registered Nurse (RN) license. - Clinical training in an acute care or ambulatory environment. - Special Skills: Familiarity with an electronic practice management system/EMR. Ability to independently assess, evaluate and interpret clinical information. Ability to identify claim correction opportunities via detailed chart reviews. Demonstrated analytical skills, including the ability to understand clinical compliance guidelines, complex reimbursement structures and the ability to apply contractual and governmental regulations to internal processes. Must possess excellent verbal, written, and interpersonal skills. Strong organizational and time management skills. Mature judgement, self-motivated, and ability to work independently. Schedule, organize, and complete work in accordance with deadlines. Ability to collaborate effectively with all levels of staff. Must possess basic computer skills with Microsoft Word and Excel. Preferred Qualifications: - 3-5 years broad clinical experience in an ambulatory setting preferred. - Bachelors of Science in Nursing preferred. - Certified coder (CPC) preferred. - Chronic disease management training preferred. - Clinical training in managed care capitated healthcare environment preferred. - Knowledge of evidence based clinical practice guidelines preferred. - Preferred Special Skills: High proficiency with an electronic practice management system/EMR. Strong clinical assessment and critical thinking skills. Ability to demonstrate leadership skills to delegate and provide direction and guidance to multidisciplinary team. Knowledge of capitation/HMO, insurance payers and government healthcare plans. Must possess intermediate computer skills with Microsoft Word and Excel and be proficient in report generation and other computer applications. Possess strong process management skills.
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