[Remote] Clinical Documentation Specialist, First Reviewer

Note: The job is a remote job and is open to candidates in USA. SSM Health is a healthcare organization seeking a Clinical Documentation Specialist, First Reviewer. The role involves performing concurrent analytical reviews of clinical and coding data to improve physician documentation, ensuring accurate reflection of patient conditions and facilitating resolution of queries with the patient care team. Responsibilities • Completes initial reviews of patient records and evaluates documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of illness (SOI). Maintains appropriate productivity level • Conducts follow-up reviews of patients every to support and assign a working or final DRG assignment upon patient discharge, as necessary • Queries physicians regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the health record when needed. Identifies issues with reporting of diagnostic testing proactively. Enhances expertise in query development, presentation, and standards including understanding of published query guidelines and practice expectations for compliance • Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record • Attends department meetings to review documentation related issues. Conducts independent research to promote knowledge of clinical topics, coding guidelines, regulatory policies and trends, and healthcare economics • Collaborates with coding to reconcile the DRG and resolves mismatches utilizing the escalation policy. Troubleshoots documentation or communication problems proactively and appropriately escalates • Reviews and clarifies clinical issues in the health record with the coding professionals that would support an accurate DRG assignment, SOI, and/or ROM. Assists in the mortality review and risk adjustment process utilizing third-party models • Demonstrates an understanding of complications, comorbidities, SOI, ROM, case mix, and the impact of procedures on the billed record. Imparts knowledge to providers and other members of the healthcare team. Maintains a level of expertise by attending continuing education programs • Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service • Works in a constant state of alertness and safe manner • Performs other duties as assigned Skills • 1 year of experience as a Clinical Documentation Specialist • Additional Two years' in an acute care setting or relevant experience • Graduate of accredited school of nursing, PA, NP, or medical school, or Associate's degree and Certified Clinical Documentation Specialist (CCDS) certification from the Association of Clinical Documentation Improvement Specialist (ACDIS) • Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS) • Or Physician Assistant in Medicine, Licensed - Illinois Department of Financial and Professional Regulation (IDFPR) • Or Physician - Regional MSO Credentialing • Or Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) • Or Advanced Practice Nurse (APN) - Illinois Department of Financial and Professional Regulation (IDFPR) • Or APN Controlled Substance - Illinois Department of Financial and Professional Regulation (IDFPR) • Or Full Practice Authority APRN Control Substance - Illinois Department of Financial and Professional Regulation (IDFPR) • Or Full Practice Authority APRN - Illinois Department of Financial and Professional Regulation (IDFPR) • Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS) • Or Physician Assistant - Missouri Division of Professional Registration • Or Physician - Regional MSO Credentialing • Or Registered Nurse (RN) Issued by Compact State • Or Registered Nurse (RN) - Missouri Division of Professional Registration • Or Nurse Practitioner - Missouri Division of Professional Registration • Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS) • Or Acknowledgement of Receipt of Application for Physician Assistant - Oklahoma Medical Board • Or Physician Assistant - Oklahoma Medical Board • Or Physician - Regional MSO Credentialing • Or Registered Nurse (RN) Issued by Compact State • Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) • Or Advanced Practice Registered Nurse (APRN) - Oklahoma Board of Nursing (OBN) • Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS) • Or Physician Assistant - Wisconsin Department of Safety and Professional Services • Or Physician - Regional MSO Credentialing • Or Registered Nurse (RN) Issued by Compact State • Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services • Or Advanced Practice Nurse Prescriber (APNP) - Wisconsin Department of Safety and Professional Services • CCDS certification • Proficiency with MS Office Tool - especially Excel • Prior experience reviewing PSI (patient safety indicator) or experience with Vizient specialized mortality reviews Benefits • Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). • Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. • Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. Company Overview • SSM Health is a Catholic, not-for-profit health system. It was founded in 1872, and is headquartered in St Louis, Missouri, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship • SSM Health has a track record of offering H1B sponsorships, with 4 in 2024, 6 in 2023, 2 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply tot his job