Compliance Documentation Specialist at AdventHealth Waterman


Category
Medical/Health
Company
AdventHealth Waterman
Location
TAVARES, FL 32778
Posted
01/07/2019

Description
Compliance Documentation Specialist AdventHealth Waterman
Location Address: 1000 Waterman Way Tavares, Florida 32778
Top Reasons to Work at AdventHealth Waterman
  • Immediate Health Insurance Coverage
  • Great benefits such as: Onsite daycare, educational reimbursement
  • State of the art unit with “Pod” Structure
  • Career growth and advancement potential
  • High quality of life with low cost of living just outside of Orlando, Florida
Work Hours/Shift:
Full Time / Day
 
You Will Be Responsible For:
Facilitates modifications to clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a DRG based payor (Medicare, Medicaid, Champus, BCBS).
  • Facilitates modifications to clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a DRG based payor (Medicare, Medicaid, Champus, BCBS).
  • Demonstrates knowledge of DRG payor issues, documentation opportunities, clinical documentation requirements, and referral policies and procedures.
  • Develops and coordinates meetings, in-services and orientation to compliance documentation program.
  • Manages day-to-day and long term intense program oversight and is responsible for increasing program awareness and performance to senior administration and physician leadership.
  • Coordinates and is responsible for the training for the CDS team, physicians and other disciplines in the hospital as indicated. Educates on clinical documentation opportunities, coding and reimbursement issues, as well as performance improvement methodologies.
  • Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes.  Gathers and submits statistical data on an ongoing basis and will generate reports as needed.
  • Performs accurate and timely review of electronic health record to initiate work sheets on DRG payers for inpatient admissions.
  • Demonstrates the ability to analyze and identify areas of potential gaps representing opportunities for documentation improvement  in order to reflect severity/complexity profile
  • Possess the ability to formulate clinically credible documentation/ clarifications/queries; utilizing effective and appropriate communication options for physician follow up, which will occur in a timely manner.
  • Demonstrates efficiency in JATA guidelines, software and accurate input of data into CDMP Trak. 
  • Knowledge of Medicare Part A as well as regulatory requirements will be demonstrated by appropriate assignment of principal diagnosis and surgical procedure(s).
  • Possession of analytical based concepts, critical thinking, problem solving and deductive reasoning skills in regards to patient health assessment and disease entities shall be evidenced in achievement of optimum DRG assignment.
  • Process discharges by updating the DRG Worksheet to reflect any changes in status, procedures/treatments, and conferring with physician to finalize diagnoses.
  • Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded in the patient’s chart.
Qualifications
What You Will Need:
  • RN – registered nurse
  • Minimum 5 years of recent hospital experience
  • State of Florida Registered Nursing License
  • BSN preferred
  • ICU, CCU or strong Med/Surg experience preferred.
  • Utilization Review or coding experience preferred
  • BSN or MA preferred
  • CCDS – Certified Clinical Documentation Specialist
 
Job Summary:
Under general supervision of the Director of Case Management, the clinical documentation coordinator has oversight for the compliant documentation management program.  Works concurrently with physicians, nursing, case management and the coding department to facilitate the accurate representation of severity of illness and intensity of service and to ensure coding accuracy for the delivery of care.   Analyzes and monitors the statistical data from JA Thomas/Nuance Communications for continued performance improvement and accuracy.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.