Department: 10169 Atrium Health Floyd Medical Center - Clinical Documentation Improvement
Status: Full time
Benefits Eligible: Yes
Hou rs Per Week: 40
Schedule Details/Additional Information: Varies
Documentation Specialist Last Modified:12/11/2019
Job Code 107C3 Job Title Documentation Specialist Department Code 100905 Department Name Coordinated Care
Template Used: I POSITION SUMMARY - The Documentation Specialist reviews Medicare inpatient medical records to ensure appropriate documentation. He/she works with HIM coding staff to ensure understanding of coding rules and methodologies and makes certain that appropriate education and follow-up occurs with providers to ensure compliance.
QUALIFICATIONS - EDUCATION REQUIRED
- Graduate of an accredited School of Professional Nursing
- EDUCATION PREFERRED
- LICENSURES OR CERTIFICATIONS REQUIRED
- Valid, active unencumbered Nursing license approved by the Georgia Licensing Board
- LICENSURES OR CERTIFICATIONS PREFERRED
- EXPERIENCE REQUIRED
- 5 or moreyears hospital experience caring for short term acute patients
- Comprehensive understanding of reimbursement mechanisms
- EXPERIENCE PREFERRED
- Participation in chart review and medical record coding
ROLE SPECIFIC ESSENTIAL DUTIES AND RESPONSIBILITIES - Reviews Medicare inpatient medical records to ensure appropriate documentation of co-morbidities and complicating diagnoses.
- Manages daily work list of patients meeting priority list diagnoses for documentation improvementincluding top volume/variance DRG pairs, Pneumonia (DRG089, Respiratory (DRG 079), Sepsis (DRG 320, 321, and 416).
- Queries appropriate physician for necessary documentation.
- Follows-up to ensure query response from physician.
- Maintains database on queries, response to query and documentation outcomes.
- Uses database reports to identify physician education needs and to report on success of documentation program.
- Develops and provides education programs to appropriate providers.
- Acts as a resource to the Utilization Managers for early assignment of a working DRG on all Medicare patients.
- Provides education/training to other UM staff to maintain a backup to the documentation specialist in case of time off.Coordinates patient care throughout inpatient or observation stays.
- Actively participates in Performance Improvement (PI) processes.
- Actively participates in departmental and organization-wide Lean/Six Sigma program 100 day workouts.
- Maintains workload to ensure progress towards departmental goals and objectives.
- Identifies, documents and reports variances, quality, cost and risk issues to management.
- Supports and participates in the review and modification of policies, procedures and processes.
- Performs other related duties as assigned.
Total Score: 0 Total Possible Score: 0 Pay Range $37.50 - $56.25
Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more - Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
