What are the responsibilities and job description for the OUTPATIENT CLINICAL DOCUMENTATION SPECIALIST RN position at Covenant HealthCare?
Covenant HealthCare
Summary:
The Outpatient Clinical Documentation Specialist is responsible for activities which improve the accuracy of facility outpatient clinical documentation and charging including education with the clinical departments and root cause correction to support accurate charging and coding in compliance with Hospital policies. The OP CDS assists clinical areas to effectively document services and understand the relationship of documentation, medical necessity, and charging for the services provided in accordance with Hospital and procedures.
Responsibilities:
1. Conducts chart reviews of assigned clinical departments to regularly review the documentation and charge accuracy and to integrate into educational sessions with the clinical departments and medical staff
2. Performs shadowing and coaching with key stakeholders in the clinical departments to facilitate adoption of best practices and improve documentation and charging accuracy
3. Takes ownership and initiative to build upon documentation and charge capture processes for identified areas of opportunity
4. Provides reporting and feedback to the clinical departments based on claim accuracy and chart reviews to encourage greater understanding and ownership of documentation and charge accuracy
5. Performs review of accounts identified as potentially missing charges and conducts additional research to help resolve the areas of opportunity and identify the root cause of the issues causing the missed charges
6. Coordinates with clinical departments as well as Coding, PFS, CDM, Finance and others to review and correct claims and identify and resolve root cause issues
7. Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities, summarizes data and prepares summary materials for discussion with clinical and/or finance teams
8. Fosters teamwork and utilizes strong team building measures.
9. Develops and maintains project plans and project tracking, including documentation of project meetings and project issues lists
10. Maintains current knowledge of applicable regulatory standards, which may impact utilization of processes and systems
11. Works with finance to track revenue indicators and corresponding action plans
12. Conduct auditing and monitoring of assigned areas
13. Maintains strict confidentiality of all patient, employee, and physician information according to HIPAA guidelines.
14. All other duties as assigned.
Other Job Responsibilities
1. Shares in the We Care Values, demonstrates its values, supports its philosophy and is sensitive to its mission. Demonstrates knowledge of and follows Departmental, and Hospital policies and procedures as outlined on CoveNet.
2. Seeks out opportunities for individual growth and development, including attending various meetings, conferences, courses, seeking certifications (i.e. CPC), as required.
3. Uses tact and sensitivity when communicating with patients, visitors, co-workers, and other Health System personnel.
4. Serves on department and/or institutional committees as requested.
1. Education: Bachelor’s degree or over five years of related healthcare experience in lieu of degree.
2.RN with current license in the State of Michigan.
3. Experience: Five or more years of healthcare knowledge typically obtained from experience as a clinical caregiver or manager, coding specialist, and/or a revenue management/cycle professional staff person.
4. General understanding of hospital-based outpatient charging, coding, and/or revenue capture functions.
5. Knowledge of APC and OPPS reimbursement structures preferred.
6. Possesses strong project management skills.
7. Possesses strong interpersonal skills, with demonstrated success at communicating effectively with all levels of the organization, especially senior leadership and department heads.
8. Demonstrates skilled ability and comfort with electronic medical records (EPIC preferred), and hospital billing functions.
9. Proficient with Microsoft Office computer applications (Excel, Word, and Power Point).
10. Effective organizational skills with the ability to prioritize and manage multiple functions and responsibilities simultaneously.
11. Ability to organize and work with minimum supervision at a high level of motivation and initiative while being entrepreneurial, creative and results oriented.
12. Effective verbal and written communication skills, good listening skills, and the ability to interpret end users’ needs.
13. Strong problem solving and investigative skills.
