Company: RCM Health Care Services
Job Category: Healthcare Services
Location: New York City
Position Type: Full Time
Job Title: RN Clinical Documentation Specialist

Resume: future@ezecastlesoftware.com

JOB DESCRIPTION:
Responsible for facilitating improvement of inpatient medical record documentation by intervening and interacting with, as well as educating physicians, residents, and other licensed independent practitioners.

• Responsible for responding to retrospective requests for clinical information required for reimbursement and retrospective denials from third party payers.
• Initiates and maintains records and databases to quantify impact of interventions and ensure follow through with recommendations.
• Identifies, investigates, and evaluates practices and processes to facilitate continuous improvement in complete and accurate medical record documentation.
• Reviews determinations from third party payers, obtains and reviews the medical record to determine if an appeal is appropriate and responds directly or consults with the responsible M.D. or other professional staff, when necessary.
• Provides clinical information pertinent to the patient’s stay in the hospital as outlined in the provider agreements negotiated by the Managed Care Department maximizing reimbursement to the hospital within the required time frames.
• Maintains knowledge of third party requirements and policies regarding utilization review and case management.
• Maintains knowledge of ICD9 and DRG coding.

Qualifications include:

• Bachelor’s degree in healthcare required – BSN preferred.
• 5 years acute care hospital experience required.
• Computer literacy and ability to efficiently and effectively obtain clinical information from a variety of electronic sources necessary.

REQUIREMENTS:

• Must be a NY State RN with an Active license and registration
• Third Party payer requirements for DI/RI.
• ICD9 and DRG Coding.
• Knowledge of Milliman Care Guidelines.