Clinical Document Improvement Specialist ( Job Number: 194225 )
Location: Rockville, Maryland
Description: Kaiser Permanente is at present looking to employ Clinical Document Improvement Specialist ( Job Number: 194225 ) right now, this career will be assigned in Maryland. Further informations about this career opportunity kindly see the descriptions. Responsible for working collaboratively w/ Senior Managers & MAPMG in the development & implementation of HI! MS & Coding activities & programs that ensure high quality, effective documentation & coding requirements that meets HIMS Medicare targets & goals. To facilitate the accurate representation of the severity of illness by improving the quality of the clinical documentation & ensure constant compliance readiness state for HIMS & Coding department by assessing potential vulnerabilities through systematic & appropriate gap analyses, interventions & corrective actions.
Essential Functions:
- Implements quality review processes to ensure appropriate clinical documentation is captured to support diagnosis & to ensure the level of service rendered to all patients is accurately reflected in the record.
- Reviews encounters against data mining reports to ensure all identified clinical indicators for focused HCCs (hierarchical chronic conditions) are documented or clarified as outlined in department procedures related to the query process.
- Mon! itors & screens cases for quality concerns or issues related t! o quality improvement processes.
- Identifies & collects appropriate data; incorporates quality improvement tools & methodology in all assignments.
- Provides staff support for coding improvement activities on a regional or a departmental level.
- Works closely & collaboratively w/ the HIMS management leadership & Quality department on accreditation & licensing requirements to ensure all documentation is compliant w/ local, state, federal & accreditation requirements.
- Acts as a liaison & facilitator for quality reports related to database tracking, quality trends & analysis & specific focused studies, as assigned.
- Develops & maintains quality management systems, standards & criteria for reporting aggregate data & focused review findings & results in collaboration w/ the HIMS Management Leadership, medical group & other designated departments.
- Demonstrates familiarity w/ practitioner peer review methods to facilitate the proces! s of unbiased case review w/ strict adherence to confidentiality & protection of sensitive information & findings.
- Advances the quality & service improvement priorities of the region by using a variety of quality strategies, tools & techniques.
- Performs other duties as directed.
Basic Qualifications:
- 6 years of clinical experience (i.e., inpatient, ambulatory, clinical documentation, discharge planning, case management) working w/ Managed Care/HMO or equivalent health care experience required.
- 3 years of experience in quality review or other related areas of practice required.
- BSN or bachelor's degree in a health care related field required.
- Experience in quality improvement activities w/ ability to work as a consultant, facilitator & colleague w/ other Quality Management staff, physicians & KP staff at all levels of the organization required.
- Demonstrated ability to! conduct & interpret quantitative & qualitative analysis required. !
- Strong computer skills & use of databases required.
- Knowledge &/or experience w/ NCQA, AAAHC, state & federal regulations required.
- Knowledge of Medicare requirements required.
- Master's degree in a health care related field preferred.
- Professional Clinical License, such as: Register Nurse, Social Worker, Pharmacist, strongly preferred.
- Registered Health information Technician (RHIT), or Certified Coding specialist (CCS) or Certified Professional Coder (CPC) preferred.
- Understand coding classification systems such as, but not limited to ICD-9-CM, Current Procedural Terminology (CPT), health care common Procedural Coding (HCPCS), HCC, strongly preferred.
- Excellent written & verbal communication skills preferred.
- Excellent interpersonal skills preferred.
- Self motivation preferred.
- Ability to work independently w/ minimal supervision pre! ferred.
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If you were eligible to this career, please give us your resume, with salary requirements and a resume to Kaiser Permanente.
Interested on this career, just click on the Apply button, you will be redirected to the official website
This career will be opened on: Mon, 22 Jul 2013 16:57:50 GMT
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