Clinical Documentation Specialist

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This Job Improves the overall quality and completeness of medical documentation; facilitates enhancements to clinical documentation through extensive interaction with physicians, nursing staff, case managers, other patient caregivers, and medical records coding staff to ensure that the appropriate reimbursement is received for the level of service rendered to all inpatients; ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes; educates all members of the patient care team on an ongoing basis. ESSENTIAL RESPONSIBILITIES Review inpatient medical records for identified payor populations and analyze clinical information to identify areas within the medical record for potential gaps in physician documentation. (35%) Formulate credible clinical documentation clarifications to improve clinical documentation of principal diagnosis, comorbidities, present on admission (POA) and/or quality measures. (35%) Facilitate modifications to clinical documentation through extensive interaction with physicians, nurses and ancillary staff based on knowledge of DRG assignment, documentation strategies, and clinical documentation requirements. (10%) Work collaboratively with coding professionals to assure documentation of discharge diagnoses and comorbidities are a complete reflection of the patient's clinical status and care. (10%) Educates all internal customers on compliant documentation responsibilities, coding and reimbursement issues, as well as performance improvement methodologies. (10%) QUALIFICATIONS: Required 5 years Coding experience in an acute care adult inpatient hospital setting High School/GED Associates degree with one year certificate from college or technical school OR 3 to 6 months of related experience and/or training; or equivalent combination of education and experience. Certified Coding Specialist (CCS) Certification Preferred 2 years Clinical Documentation Specialist experience in an acute inpatient facility Experience with 3M Encoder and/or Abstracting Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Last edited: 2/8/2023 Pay Range Minimum: $28.18 Pay Range Maximum: $43.80 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. 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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.