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CorroHealth
United States (remote)
10 days ago
Texas Health Resources
Arlington, Arlington, United States (remote)
14 days ago
American Physician Scientists Association
United States (remote)
14 days ago
TeleSpecialists
Remote, United States (remote)
30+ days ago
The Permanente Medical Group, Inc.
California, United States (remote)
30+ days ago
CorroHealth
United States
(remote)
10 days ago
Job Type
Full-Time
Job Duration
Indefinite
Min Experience
5-7 Years
Min Education
Master's Degree
Required Travel
None
Job Function
CDI/ Clinical Documentation Improvement

Description

Physician Clinical Reviewer will review charts to facilitate accurate representation of patient’s true clinical picture in the codes assigned by the coders. The Physician Clinical Reviewer will ensure that all reviewed charts capture the true clinical picture in compliance with federal laws, ICD-10 and CPT coding guidelines, along with supporting medical necessity considering NCDs, LCDs, InterQual criteria and Milliman Care Guidelines (MCG) to prevent denials. The Physician Clinical Reviewer will also be responsible to place queries, when appropriate, following AHIMA guidelines and CorroHealth policies to get diagnosis/procedure clarification and validity as it pertains to code assignment, code sequencing, severity of illness (SOI), risk of mortality (ROM), Hierarchical Condition Category (HCC) capture, and case mix data, as well as timely, accurate and complete documentation of clinical information used for measuring and reporting physician and facility outcomes. Additionally, Physician Clinical Reviewer may also be required to audit clients’ clinical documentation integrity (CDI) program to include query review, analysis of coding, and overall program accuracy.



Requirements

Important Duties and Responsibilities:

  • Adherence to all coding guidelines and CDI best practices, as endorsed by ACDIS and AHIMA, to determine correct coding that is clinically supported
  • Analyze records for potential query opportunities and appropriate code assignment and code sequencing
  • Maintain quality of reviews and making sure the true clinical picture is captured, along with ensuring Physician Team chart review productivity
  • Staying up to date with official coding guidelines and coding clinics
  • Available to provide training to other new hires, if required, along with supporting development of training materials, as well as clinical, coding and CDI policies
  • Assisting with project data analysis, reporting, and feedback both internally and to clients
  • In all situations, protecting the privacy and confidentiality of patient health and client information, and follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices, standards, and procedures
  • Conduct chart reviews as assigned, meeting the productivity standards as set forth for each project or record type
  • Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
  • When interacting with clients, always conducts himself/herself in a professional manner, exhibiting excellent relationship, work performance and communication skill so as to support the company and its business interests
  • Maintenance of professional credentials and knowledge of CDI, coding, reimbursement, and compliance issues through continuing education
  • Other duties and responsibilities, as assigned

Education & Credentials:

  • Graduate from an accredited medical school that is listed in the World Directory of Medical Schools at https://search.wdoms.org/
  • Graduation from an ACGME-accredited US residency program is preferred but NOT a requirement
  • Recognized CDI credential from ACDIS (CCDS) and/or AHIMA (CDIP)
  • Recognized coding credential from AHIMA (CCS) 

Work Experience:

  • Five or more years working in an acute care setting as a Clinical Documentation Specialist (CDS)
  • Prior experience of working as a Clinical and Coding validation auditor is a requirement
  • Prior experience of working in inpatient case management or utilization review is preferred but NOT a requirement

Knowledge, Skills & Abilities:

  • Experience with telecommuting and electronic medical record systems required
  • Good computer skills and familiarity with commonly used work apps, such as MS Word, MS Excel, MS Outlook, etc.
  • Strong analytical skills
  • Works well with numbers, using basic math skills
  • Strong team player
  • Ability to work with multiple and diverse clients and projects
  • Ability to work with minimal supervision
  • Ability to maintain and access multiple files

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Job ID: 69722295

Please refer to the company's website or job descriptions to learn more about them.

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