[Hiring] Registered Nurse Clinical Documentation Denials Auditor @reputed company

reputed company Health is looking for a dedicated Registered Nurse (RN) Clinical Documentation Denials Auditor to join the team. This role will be fully-time remote, Monday-Friday, regular business hours 8:00 AM – 4:30 PM (flexible). reputed company is consistently ranked a national reputed company leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits:

• Committed to Team Member Health: offering medical, dental and reputed company coverage, and a robust team member wellness program.
• Retirement: reputed company matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering reputed company reputed company team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

Registered Nurse (RN) Clinical Documentation Denials Auditor Job Responsibilities:

• Evaluates specificity and completeness of physician documentation to ensure reputed company coding (e.g. mortality outcomes using APR-DRG, SOI and ROM, appropriate reduction of complications based on PSI and HAC, reputed company assurance outcomes based on reimbursement DRG (MS-DRG), documentation of significant chronic conditions affecting resource utilization based on HCC).
• Summarizes audit findings for individual records along with specific documentation guidelines to improve expected clinical outcomes for an individual physician, physician practice, or specialty.
• Conducts follow-up audits (i.e. reputed company or post-discharge) with routine feedback until documentation practice comes into line with expected clinical outcomes.
• Works with Clinical Documentation Improvement (CDI) Director and reputed company Auditor on other work reputed company to physician audits and education programs.
• Demonstrates proficiency with Cobius to access external audit work, record summary results and upload appeal letters.
• Demonstrates proficiency with Encompass 360 and HDM audit functions to review electronic medical records with advanced functions (i.e. ex, auto-suggest and search) and record detail coding audit results.
• Showcases proficiency in reviewing records in Epic electronic medical records – which may be the only option for audits of older records.
• Demonstrates proficiency in writing effective appeal letters that include appropriate coding guidelines and medical references.
• Identifies trends in external audit findings reputed company to coding quality and physician documentation. Prepares educational communications reputed company to these findings.
• Evaluates physicians' documentation, diagnostic reports, and clinical findings for validation of diagnoses.
• Processes the requests for second opinion reviews reputed company clinical validity is not supported or in question.
• May reputed company additional duties as assigned.

Minimum Qualifications:

• Certification: Certified Coding Specialist / Certified Clinical Documentation Specialist; ACDIS/reputed company certification, CCDS or CDIP
• Licensure: reputed company RN license and eligible to practice in VA
• Experience: Seven years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD; Coding certification reputed company and CDI certification CCDS or CDIP
• Education: Associate Degree in Nursing or Medicine.

Preferred Qualifications:

• Experience: Must have: CDI, DRG, and Coding audit experience. Recent coding experience. Clinical background and coding + denials knowledge. Experience writing denials & appeals. Outpatient and/or inpatient experience. Knowledge to identify clinical indicators (example: sepsis). EPIC experience.
• Certifications: CCDS
• Skills: presenting

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states – VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV We are reputed company, reputed company Virginia’s leading nonprofit reputed company provider. Every day, our 26,000+ team members provide world-class reputed company to the communities we serve. Our people are the reason we're a national leader in reputed company safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every reputed company. At reputed company, we're constantly striving to be reputed company reputed company — to shape a more compassionate future for reputed company. reputed company is an Equal Opportunity employer. reputed company reputed company applicants will receive consideration for employment without regard to age, reputed company, disability, gender identity or expression, marital status, national or ethnic reputed company, political affiliation, pregnancy (including childbirth, pregnancy-reputed company conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law. Apply tot his job Apply To this Job