VCU Health System's Clinical Documentation Improvement department is seeking a full time Clin Doc Review Auditor. This position will identify areas for improvement to fully and accurately reflect patient acuity, risk of mortality, co-morbidity and DRG assignment through an in-depth review of the clinical record in light of work performed by the Clinical Documentation Improvement (CDI) team. Recognize areas of improvement through review of concurrent and retrospective patient records. Focus of these audits will be related to overall team effectiveness, individual performance and situations where the final coded DRG does not match the Clinical Documentation Specialist's working DRG.
Evaluates Patient Safety Indicators (PSI), Hospital Acquired Conditions (HAC), and Mortality (Expired) records, as well as reconciles any DRG incongruences between the Coding and CDI departments.
Partners with Clinical Documentation & Coding Educator to correlate audit findings with appropriate educational follow up.
Assists with review compliance audit requests as well as outside random audit and third - party audit requests and draft appeal letters.
Partners with denials management and regulatory review team to stay updated on payer focused areas for coding, documentation and billing.
Assists education teams in assuring industry best practices for compliance in clinical documentation and coding.
Bachelor's Degree in Nursing from an accredited School of Nursing
Current RN licensure in Virginia or eligible and Clinical Documentation Improvement Professional (CDIP) through AHIMA or Certified Clinical Documentation Specialist (CCDS) Along with one or more of the following: Certified Coding Specialist (CCS) from AHIMA or Registered Health Information Technologist (RHIT) from AHIMA or Registered Health Information Administrator (RHIA) from AHIMA
Minimum of three (3) years of clinical experience
Previous work experience with APR-DRG's, Severity of Illness (SOI) and Risk of Mortality (ROM)
Previous work experience with coding and clinical documentation software
Previous experience in reviewing PSI, HAC, Mortality and other quality indicators
Advanced level experience with personal computers and Microsoft applications to include Word, Excel, Access and PowerPoint and e-mail applications
Strong analytical, interpretive, communication, decision-making, judgment and technical writing skills.
Knowledge of Health Information Security and Privacy standards
Master of Science in Nursing or Master of Healthcare Administration or Master of Science in Nursing Education or Master of Science in Health Information Management or Healthcare Administration
Five (5) years as a Clinical Documentation Specialist in an Acute Care Level Integrated Health System
Five (5) years serving in an audit capacity within hospital quality operations, reimbursement (coding, billing, or charging) audits, and/or clinical compliance (JCAHO readiness evaluations) audits
Qualified applicants will receive consideration for employment without regard to their protected veteran or disability status.