Clinical Documentation Specialist St Anthony Hospital:
Centura Health

120654-en_US
Centura Health
Westminster Colorado
Healthcare
Description

Centura Health connects individuals, families and neighborhoods across Colorado and western Kansas with more than 21,000 of the most talented hearts and minds in medicine.



 



Through Centura Health’s 17 hospitals, two senior living communities, health neighborhoods, physician clinics, Flight for Life® Colorado, home care and hospice services, we offer a diverse range of work settings in a Colorado or Kansas community you will love to call home.



Enjoy amazing people, competitive pay, some of the best benefits in the industry and plenty of opportunity for professional growth and development.



 



If you’re ready to discover the difference of working for a fully-integrated health system with a non-profit, faith-based mission to care, we look forward to receiving your application.



Job Description/Job Posting ID: 120654



Recruiter Contact: MandyGray@Centura.org



Schedule: Monday - Friday



Shift: FT Days- 1.00 FTE


Position Summary



Under indirect supervision, facilitates and obtains appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient. Educates members of the patient care team regarding documentation guidelines and regulatory requirements, including attending physicians, allied health practitioners, nursing, and case management. Supports timely, accurate, and complete documentation of clinical information used for measuring and reporting hospital and physician-based outcomes. Works independently majority of the time.



 



Minimum Education Requirements




  • Graduate of an accredited School of Nursing.

  • BSN Preferred

  • Advance knowledge of anatomy and physiology, medical terminology, pharmacology, pathophysiology and disease process

  • Preferred knowledge of DRG assignments, ICD-9 codes, regulatory coding guidelines, and Medicare Part A and Part B regulatory guidelines



 



Minimum Experience Requirements




  • 3 years nursing experience required and experience in case management, health information management or utilization review preferred

  • Clinical documentation and/or clinical experience preferred with ICU, CCU or strong Med/Surg experience

  • Excellent organization, analytical, writing and interpersonal skills

  • Dependable and self-directed with excellent critical thinking, problem-solving and deductive reasoning skills

  • Excellent communication, computer, critical thinking, organization skills and multi-disciplinary tasks.

  • Exhibits knowledge of clinical documentation requirements, DRG assignment, and clinical conditions and/or procedures

  • Understand and communicate differences between Medicare Part A and Part B guidelines and how they impact DRG assignments

  • Advance knowledge of Microsoft Office applications and troubleshooting computer problems

  • Understand and support compliant documentation management strategies that touches all the critical aspects of the hospital’s clinical documentation process



 



License/Certifications




  • Current Colorado RN license or AHIMA certification (i.e. RHIT, RHIA or CCS) required and maintained.



 



Position Duties (essential functions denoted with an * )




  • Demonstrates excellence in communication skills and interpersonal relations adheres to hospital policies and procedures and actively promotes the mission and core values of the organization.*

  • Assumes leadership role to assist in improving the overall quality and completeness of physician clinical documentation by performing admission and continued stay reviews using clinical documentation and coding guidelines and Milliman criteria.*

  • Supports timely, accurate, and complete documentation of clinical information used for measuring and reporting hospital and physician-based outcomes. *

  • Facilitates and obtains appropriate physicians documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care rendered to all patients with DRG-based payers.*

  • Demonstrates knowledge of DRG’s, clinical documentation requirements, and referral policies and procedures.

  • Able to effectively educate Physicians, coders and others on clinical documentation, coding and reimbursement opportunities.*

  • Educates members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and case management.*

  • Works independently in an effective and responsible manner.*



 



Physical Requirements



Sedentary Work - prolonged periods of sitting and exert/lift up to 10 lbs. force occasionally)



 



**An in person competency clinical exam is required before interviewing for this role**



 



ZIPJOB


 



Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V. 

Basic Qualifications
Requirement