Company :

Job Description : 

While this is a primarily remote/work from home role, qualified candidates must live within 50 miles of the Greater Pittsburgh or Greater Erie regions

GENERAL OVERVIEW:

Improves the overall quality and completeness of medical documentation; facilitates enhancements to clinical documentation through extensive interaction with physicians, nursing staff, case managers, other patient caregivers, and medical records coding staff to ensure that the appropriate reimbursement is received for the level of service rendered to all inpatients; ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes; educates all members of the patient care team on an ongoing basis.

ESSENTIAL RESPONSIBILITIES:

• Facilitate appropriate clinical documentation through concurrent, prospective, and retrospective medical record review (30%)
• Facilitate modifications to clinical documentation through extensive interaction with physicians, nurses and ancillary staff based on knowledge of coding and HCC guidelines, documentation strategies, and clinical documentation requirements (25%)
• Work collaboratively with coding professionals to assure documentation of diagnoses and comorbidities are a complete reflection of the patient's clinical status and care (10%)
• Formulate credible clinical documentation clarifications to improve clinical documentation (10%)
• Educates all internal customers on compliant documentation responsibilities, coding, and reimbursement issues, as well as performance improvement methodologies (15%)
• Performs other duties as assigned or required (10%)

QUALIFICATIONS:

Minimum

• High school/ GED
• Bachelor's Degree in Nursing OR Relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 5 years in a nursing role
• Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)

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Preferred

• Experience in Clinical Documentation Integrity (CDI)
• Experience in Coding
• Knowledge of ICD 10 and HCC coding guidelines
• Knowledge of Electronic Medical Record (Epic)
• Knowledge of Encoder (3M 360 Encompass)
• Excellent communication skills
• Critical thinking skills 
• Certified Coding Specialist (CCS)
• Certified Outpatient Clinical Documentation Improvement Specialist (CCDS-O)
• Certified Clinical Documentation Improvement Specialist (CCDS)
• Certified Clinical Documentation Improvement Professional (CDIP)

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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