Registered Nurse - Documentation Specialist Core

Exeter Hospital, Core Physicians, and Rockingham VNA & Hospice, part of Beth Israel Lahey Health, proudly serve the beautiful NH seacoast region. Our principal mission is to work together to create healthier communities. What makes us unique is the spirit of our staff who are team-oriented and focused on providing an outstanding patient care experience and quality outcomes for those we are privileged to serve. In addition, we want to ensure that our employees feel well cared for by offering a comprehensive benefits package, on-going training and growth opportunities, wellness resources, special perks, and more.

Our Magnet designation is recognition of our excellent nursing staff and the high quality, innovative patient care we deliver every day in our community.

Serves as the liaison between our providers and insurance payers supporting various programs related to the annual coding of chronic conditions as well as the closing of gaps in care.  Conducts retrospective review and provide proactive outreach and coordination between medical staff, patients, and insurance companies to ensure accuracy and completeness of chronic condition coding & documentation.

Requirements:

• 1-3 year’s direct experience
• Graduate of Accredited RN Program
• RN license - NH or other Compact State
• BLS within 6 months of hire
• MS Office
• EMR/Practice Management software
• CPC or CRC certification through AAPC or CDI or CCS certification through AHIMA, is encouraged

Major Responsibilities:

1. Conducts concurrent and retrospective medical record reviews to ensure accurate and specific documentation of diagnoses.
2. Identifies error and issues related to coding and documentation.
3. Collaborates with the coding staff & providers to ensure that the medical record has the necessary documentation to support accurate coding.
4. Works collaboratively and cooperatively with payers to ensure fulfillment of requirements needed to meet thresholds for incentive programs and attends joint operating committee meetings.
5. Works collaboratively with our Quality Metrics Coordinator to complete comprehensive documentation of quality measures and clinical conditions, as appropriate.
6. Works directly with the Director of Revenue and Payer Contracts to manage the expectations and performance of the quality based contracts.
7. Works within payer-specific online portals to ensure patient record accuracy and provide proactive action-planning to achieve program targets.  In addition, completes manual attestation work as well as forms required by the payers to close gaps in care.
8. Works collaboratively with the Payer Performance committee to provide regular updates on progress towards goals.
9. Conducts patient outreach activities, in coordination with clinical administration and the Quality Metrics Coordinator, to ensure patients are seen by their provider at least once per year to close clinical and coding gaps, as appropriate.
10. Provides other functions as directed by Core leadership, specific to chronic condition coding and gaps in care.