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Clinical Documentation Specialist

Health Information Services

Full Time -80 hours

Days

80

BASIC PURPOSE

 

In an environment of continuous quality improvement, responsible for reviewing physician documentation practices to comply with governmental regulations for standardized patient care and quality of care core measure indicators.  In this role, the Clinical Documentation Specialist will complete chart reviews, and facilitate documentation improvement through communication with the physicians in order to maintain compliance requirements for data abstraction, analysis, and reporting.

 

JOB SPECIFICATIONS/SCOPE

 

Minimum Education/Experience Required:  Graduate of an accredited school of

nursing with current license to practice as registered nurse in the State of

Ohio.  Minimum of 5 years recent experience in an acute care setting or

managed care environment. 

 

Special Knowledge, Skills, Training:  Strong organization skills,

self-directed, flexible, able to adapt to rapidly changing regulatory

requirements.  Ability to analyze, interpret and assimilate information from

various sources based on technical and experience-based knowledge.

Demonstrated knowledge in using clinical information systems, excel

spreadsheet, and reporting and/or graphing capabilities and web access to

input and research information.  Possesses effective interpersonal skills, can work across departmental boundaries, facilitates problem resolution, and

maintain a professional demeanor in difficult situations.  Demonstrate ability to work effectively with physicians.  Strong working knowledge of hospital organization, operations and its interaction with medical staff and other hospital departments.  Possess excellent verbal and written communication skills.