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Form of workAbout NYC Health + Hospitals Empower Every New Yorker - Without Exception - to Live the Healthiest Life Possible NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services.
Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible. At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Job Description Under the direction of Revenue Cycle Services, performs secondary high-level reviews and obtain appropriate physician documentation for clinical conditions or procedures to support the reporting of the appropriate level of severity of Illness and risk of mortality. Review include but not limited to the expected risk adjustment factors. Identifies educational opportunities and provides feedback to facility clinical documentation specialists, validators and clinical services.
This position also monitors facility departmental and interdisciplinary documentation performance, participates in performance improvement and research activities; maintains professional practice standards and clinical expertise; and demonstrates leadership skills. Demonstrates effective communication, planning, and organizational skills and keeps current knowledge in the clinical documentation field and all applicable Assistant directors are able to perform and support facility Clinical Documentation Specialist Level I and II responsibilities. General tasks and responsibilities will include: Performs pre-visit and/or retrospective reviews to identify appropriate physician documentation and missed query opportunities for any clinical conditions or procedures after facilities completed the cases for billing.
Facility staff oversite and on-going interaction to provide results of findings and ensure appropriate capture of diagnosis and procedures for reporting. Including but not limited to the risk adjustment factors for Clinical Risk Groups (CRGs and Hierarchical Condition Category (HCC) diagnoses for billing and reporting. Coding and clinical documentation validation and facilitate corrections for reporting and billing.
Provides consistent clinical service education on associated topics in overview facility findings. Reviews Patient Safety Indicators and Hospital Acquired Conditions for appropriate reporting and identifies opportunities for process improvement. Provide education to support accurate reporting of quality metrics in collaboration with the Patient Safety and Quality departments.
Participates in the denials review and/or processing based on industry pre-established criteria and practice as well as, facility policies and procedures. Provides feedback to facility CDIs and physician advisors on opportunities for denial reduction based on case review done by internal/external staff. Acts with latitude for independent action and judgment managing the clinical documentation improvement from the Central Office.
Manages, organizes, directs and plans and work assignments. Collaborates and educates facility Clinical Documentation Improvement leads. Participates in outpatient longitudinal clinical documentation pre-visit reviews to identify documentation opportunities to support accurate reporting HCCs, CRGs and/or Hedis/Quar providing education to the clinical care teams.
Assists in the development of policies, procedures, and guidelines, or a review and/or revision of existing ones, to support best practices for clinical documentation program. Assists with preparation and presentation of financial statistics for Enterprise -level reporting on clinical documentation monitoring/trending reviews with physician advisor and clinical leadership. Strategic planning and process improvement initiatives and activities related to clinical documentation, by providing expert-level review and assessment, and effective recommendations or solutions for improvement.
Educates Clinical staff on proper clinical documentation to support reporting, and compliance and reimbursement Acts as a liaison and key resource for clinical staff including but not limited to facility CDS, Clinicians and administrative and other appropriate staff on interpretation and application of guidelines and ethical code reporting and documentation standards and other related actions and matters; Performs other related work, as assigned. Minimum Qualifications 1. Master's degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and two (2) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, one (1) year of which must have been in a responsible administrative or managerial capacity; or 2.
Bachelor's degree from an accredited college or university in disciplines, as listed in "1" above; and three (3) years of experience, as described in "1" above, one (1) year of which must have been in a responsible administrative or managerial capacity. Department Preferences Licensed Registered Nurse or FMG Familiarity with revenue cycle and electronic medical records systems Excellent written and verbal communication skills Strong organizational skills, ability to build and lead a team. Excellent written and oral communication skills.
Strong administrative experience. One of the following: Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED); and/or, Bachelor of Science in Nursing degree from an accredited college or university; and, four (4) years of acute care experience; or valid New York State license and current registration to practice as a Nurse Practitioner (NP) issued by the NYSED; and, two (2) years of experience, as described in "1" above; or, valid New York State license and current registration to practice as a Physician Assistant (PA) issued by the NYSED; and, two (2) years of experience, as described in "1" above; or, Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or, Successful completion of education that leads to a medical degree; and, two (2) years of experience, or possession of a Registered Health Information Administrator (RHIA)(RHIT)credential from AHIMA and two (2) years of satisfactory experience in coding and abstracting medical records in a recognized hospital or healthcare organization, of which one (1) year has been in a supervisory and/or administrative capacity; or Possession of a valid certificate as a Certified Coding Specialist (CCS) from AHIMA and five (5) years of satisfactory experience in coding and abstracting medical records in a recognized hospital or healthcare organization, of which three (2) years have been in a supervisory and/or administrative capacity; or Possession of a valid certificate as CCDS or CDIP (4 years' experience as a clinical documentation specialist and 2 as a DRG validator or 3 years coding in an acute care setting. How To Apply Please be advised that proof of Covid-19 vaccination is required prior to hire.
If you wish to apply for this position, please apply online by clicking the "Apply Now" button. If applying online, please include your cover letter in the same file attachment with your uploaded resume. NYC Health and Hospitals offers a competitive benefits package that includes: Comprehensive Health Benefits for employees hired to work 20+ hrs.
per week Retirement Savings and Pension Plans Loan Forgiveness Programs for eligible employees Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts College tuition discounts and professional development opportunities Multiple employee discounts programs
