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Form of workThis position is responsible for ongoing quality review and assessment of inpatient hospital charts. Performs audits on the accuracy of clinical reviews and physician queries. Performs review of claims denied for coding, documentation and clinical validation and formulates and submits letters of appeal. Prepares reports for management review and identifies trends. Conducts focused retrospective audits and regular scheduled audits of individual clinical documentation improvement specialists. Manages all audits conducted by internal and external entities and responds to requests for code verification. In conjunction with the clinical documentation integrity manager and assistant manager, contributes to the development of educational and training opportunities for staff.
Minimum Education and Experience Requirements:
- Graduate of an accredited school of nursing with current RN licensure in the state of Florida.
- Minimum of three years of recent clinical experience in a hospital setting.
- Certified clinical documentation specialist required within the first three years of job.
- Utilization management, case management, quality improvement or inpatient coding experience preferred.
- Coding audit experience preferred.
- Must have strong knowledge of ICD-10 CM/PCS and proficiency with Microsoft Windows operating systems and Office applications, such as Word, Excel, PowerPoint and coding/grouping software.
- Able to work well with minimal supervision.
- Able to communicate clearly (both written and verbally).
- Able to generate reports for management review that present audit results in a clear manner.
- Able to meet deadlines and respond well to frequent changes in regulation.
- Able to maintain positive and productive relationships with internal and external teams and customers.
- Able to work independently and be a self-starter.
Motor Vehicle Designation:
- Employees in this position will operate vehicles for an assigned business purpose as a "non-frequent driver."
Licensure/Certification/Registration:
- Registered nurse (RN).
- Certified clinical documentation specialist required within the first three years of job.
