Clinical documentation specialist [h1.location_city]

Job Description

Responsibilities

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune corporation, annual revenues were $.8 billion in 4. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately , employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points,

an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

The Atlantic Region CBO is seeking a dynamic and talented The .

The Clinical Documentation Improvement (CDI) Nurse provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services.

The goal of concurrent review includes facilitation of appropriate physician documentation of care delivered to accurately reflect patient severity of illness and risk of mortality.

Specific reviews are both determined internally and by requirements / requests of external payers or regulatory agencies and play a significant role in reporting quality of care outcomes and in obtaining accurate and compliant reimbursement for acute care services.

Job Summary and Qualifications

The Clinical Documentation Improvement (CDI) Nurse is responsible for evaluating the appropriateness of patient charges by examining medical records, facility protocols, corporate standards, and other relevant documentation. This role involves providing charge review outcomes, developing, and coordinating educational in-services for facility staff on charging and billing issues, and analyzing denial trends to identify documentation and charging opportunities. Additionally, the analyst acts as a liaison between facility administration, the Shared Services Center, and ancillary department directors concerning charging issues, clinical documentation, and revenue opportunities.

Key Responsibilities Include :

• Review audit finding letters from third party payers to obtain a clear understanding of audited charges.
• Analyze medical records and review the charges on the UB and itemized bill line by line to confirm if audited charges are supported in the records. Identify any charges that need to be removed and any charges not previously billed that would need to be added to the UB.
• Update the charge master system as needed based on charge reviews.
• Perform charge audit reviews on high dollar claims prior to billing to ensure all billed charges are supported in the medical records and to identify any missed charges.
• Evaluate patient complaints regarding billing. Confirm if the medical records support billed charges on the UB and provide feedback to customer service.
• Evaluate billed services against relevant Medicare NCDs and LCDs and provide detailed findings.
• Perform an audit for Medicare claims prior to billing with AICD (automated implantable cardioverter defibrillator) / Pacemakers to ensure Medicare billing criteria is supported.
• Perform other detailed audits for claims as needed to identify cosmetic and organ transplant codes and charges that need to be separated from other ancillary charges.
• Identify audit trends and provide feedback to management and to UHS acute care facilities.
• Adherence to all applicable laws, regulations and guidelines.
• Provides clinical knowledge for CBO staff and consultation to management as needed.
• Other duties as assigned.

Benefit Highlights

Contact Information :

Qualifications

Education, Training, Experience and Licenses / Registrations Required :

Physical and Sensory Requirements :

Disclaimer

The Atlantic Region CBO is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and / or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.