Clinical Documentation Improvement and Audit Specialist

Company Description

With 150+ locations in 17 states, Pinnacle Dermatology is the largest multi-state female-founded and owned dermatology network in the U.S. At Pinnacle Dermatology we are united in our purpose: to educate, protect, and care for your skin. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you! Our mission is to educate communities and healthcare professionals about the importance of skin health; including skin cancer prevention, risk factors and how to achieve healthy skin through annual skin exams and dermatologic care. We strive to provide the latest proven, proactive and comprehensive dermatologic care to populations in the expanding geographies we serve by making high-quality skin care timelier and more accessible all while creating a rewarding work environment for our providers and employees.

Position Summary

Reviews patients medical records to ensure that it reflects the specific health conditions that require treatments. This ensures accurate coding of the patients health status and helps providers make better decisions and maintain their patient safety. Audit analytics for prebill or post bill DRG and clinical validation reviews to identify revenue integrity issues and opportunities. This position requires expert knowledge of MS-DRG and APR-DRG payment methodologies. You will be responsible for reviewing receivables, identifying potential revenue integrity issues, and recommending corrective actions.

Qualifications

• Associate degree in Nursing required, Bachelors degree in Nursing preferred
• Able to prioritize and manage multiple projects and demanding timelines.
• Must have current Certified Clinical Documentation Specialist (CCDS) OR Certified Documentation Improvement Practitioner (CDIP) certification.
• Must have one of the following as well: RN, MBBD, RHIT, CCS, or CCS-P.
• Experience in Dermatology is preferred
• Experience in the Modernization Medicine Software is a plus.
• Must be located in one of the following states:
  • AL, AZ, CA, DE, FL, GA, IL, IN, MD, MI, MN, MS, NC, NE, NJ, OH, OK, OR, PA, SC, TN, TX, VA, VT, WI, or WV.

Essential Responsibilities

• Reviews patient medical records and facilitates proper coding.
• Understands and applies regulatory compliance related to documentation, coding and billing for all health insurance plans.
• Validates that coding reflects medical necessity of services and facilitates appropriate coding which provides an accurate reflection and reporting of the severity of the patients illness along with expected risk of mortality and complexity of care.
• Have critical thinking skills to analyze current documentation to identify gaps.
• Facilitates appropriate modifications to documentation through extensive interactions and collaboration with physicians, coding.
• Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and pay for performance diagnosis specific quality outcomes.
• Oversees clinical documentation patterns and trends to identify areas of improvement for the pay for performance measures.
• Educates all members of the patient care team regarding clinical documentation needs, changes to clinical documentation guidelines, coding and reimbursement issues, and pay for performance documentation requirements on an on-going basis.
• Develops and conducts on-going Performance Documentation education for new staff including case managers, coders, physicians, residents, nursing and allied health professionals. Compiles, analyzes and evaluates quality and clinical data collected as part of an integrated system-wide program of clinical improvement and documentation requirements.

Pinnacle Dermatology is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.