ProFee Clinical Documentation Specialist

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

The Professional Fee (ProFee) Clinical Documentation Specialist (CDS) will serve as an advisor and expert resource for providers to improve the accuracy of clinical documentation to support patient complexity and acuity, risk profiles and professional fee billing. The CDS primarily assists providers in capturing the clinical documentation needed to accurately reflect patient acuity. The ProFee CDS will focus on pre-visit provider support, post-visit provider review, and collaboration and education with providers.

Pre-visit provider support – Provide support to providers through patient record reviews in advance of patient visits, focused on the following:

• Recapture of HCCs and other potential chronic diagnoses 
• “Clinical detective” mindset to look for new HCC diagnosis capture opportunities based on appropriate clinical indicators
• Validation of data-driven suspect diagnoses

Post-visit provider review – Perform post-visit reviews focused on what is missing from the documentation, e.g., provider work effort that is expected and likely performed by the provider but not documented. Reviews are clinically focused and entail the following:

• Chart reviews consider patient history and established conditions
• Considers the diseases typically treated by the specialty and other chronic conditions that are addressed as part of medical decision making and the treatment plan
• Assesses E/M level and identifies opportunities to reflect patient acuity and complexity to support medical decision making
• Addresses instances where the medical record may be missing clinical documentation to support diagnoses

These reviews are in contrast to coding/compliance reviews, which evaluates what is written in the encounter note

Collaboration and education with providers

• Interact with providers if they receive questions about pre-visit documentation needs or suspect diagnoses
• Collaboration and coordination with professional coders, population health, value-based care/ACO and providers
• Provide education including 1:1 feedback to providers in coordination with others in the organization
• Provides feedback to physician and leadership on the educational opportunities found as a result of reviews. Recommends improvement opportunities to documentation practices and coding changes to physician based on information
• Develops and implements training programs for physicians, front office and other staff to reinforce and/or change the documentation and coding behaviors found as a result of these reviews

Job Qualifications

Knowledge, Skills, and Abilities

1. Education: Minimum associate degree
2. Licensure / Certification: CCS-P, CPC, CRC, or other coding credential
   1. RN or LPN helpful but optional
3. Extensive clinical knowledge and understanding of pathophysiology
4. Strong critical thinking skills and utilization of clinical knowledge to identify potential clinical indicators supporting patient acuity and clarifications of the medical record  
5. Excellent written and verbal communication skills
6. Possesses strong project management skills
7. Possesses strong interpersonal skills, with demonstrated success at communicating effectively with all levels of the organization
8. Ability to work independently in a time-oriented environment
9. Demonstrates skilled ability and comfort with electronic medical records (EPIC preferred)
10. Proficient with personal computer applications (Excel, Word, and Power Point)
11. Ability to build education material that is meaningful for providers and team members
12. Strong problem solving and investigative skills

Essential Responsibilities (Project Management, Chart Review, Education)

1. Coordination with ProFee CDI Program leadership and colleagues. Fosters teamwork and utilizes strong team building measures
2. Maintains a schedule of pre-visit chart reviews to assist in highlighting relevant documentation and diagnoses in compliance with governing policies and industry guidelines. Applies a “clinical detective” mindset to identify new HCC diagnosis capture opportunities based on appropriate clinical indicators for the patient.
3. Uses performance and outcome data from third-party support to identify high priority providers
4. Creates specialty-specific education on relevant topics as identified in data analytics and from clinical encounter reviews and post-claim education chart reviews
5. Develops and maintains a systematic education schedule and approach for providers in the hospital and clinic/office setting including but not limited to complete documentation, appropriate diagnosis code selection, E/M level assignments and updates to coding guidelines.
6. Delivers ongoing feedback and education to communicate importance of complete documentation and key concepts during regular clinic or provider meetings or on individual basis, as needed
7. Upholds working knowledge and stays current on latest CMS and industry guidelines, with specific understanding of HCCs and implications for documentation
8. Maintains strict confidentiality of all patients, employee and physician information according to HIPAA guidelines
9. All other duties as assigned

Other Job Responsibilities

1. Shares in Catholic Health’s vision, demonstrates its values, supports its philosophy and is sensitive to its mission.  Demonstrates knowledge of and follows Departmental and Hospital policies and Physician Office procedures as outlined in the Employee Handbook and Policies and Procedures Manual
2. Seeks out opportunities for individual growth and development, including attending various meetings, conferences, courses, seeking certifications, as required.
3. Uses tact and sensitivity when communicating with patients, visitors, co-workers, and other Catholic Health personnel
4. Serves on department and/or institutional committees as requested

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.

Salary : $70,000 - $95,000