Job description
Thank you for considering a career at Ensemble Health Partners!
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference.
The Opportunity:
The Clinical Documentation Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate.
Essential Functions:
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Completes initial patient medical record review within 24-48 hours of patient's admission; completes subsequent reviews of patient's medical record reviews every 24-48 hours and enters review findings in CDE software system
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Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software
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Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used
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Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record
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Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters
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Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge
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Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials
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Maintains competency and accuracy in use of Clinical Documentation Excellence software programs
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Maintains and upholds all clinical documentation regulatory guidelines
Experience Required:
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Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience
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Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
Education:
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Associates Degree required - Bachelor's Degree preferred
Certification/Licensure:
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Current RN or LPN License
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CCDS (Certified Clinical Documentation Specialist) certification preferred or obtained within 6 months of hire
Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.
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Join an award-winning company
Three-time winner of “Best in KLAS” 2020-2022
2022 Top Workplaces Healthcare Industry Award
2022 Top Workplaces USA Award
2022 Top Workplaces Culture Excellence Awards
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Innovation
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Work-Life Flexibility
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Leadership
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Purpose + Values
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
- Benefit packages - We offer a variety of medical plans, retirement options, and 401k options.
- Wellness Programs – Are designed to help our associates enhance their health, including a comprehensive annual health risk assessment.
- Our Culture – Ensemble’s Associate Engagement Committee facilitates fundraising, community outreach and DEI events throughout the year.
- Growth – We invest in your professional development. Each associate receives a professional certification relevant to their field and can obtain tuition reimbursement.
- Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact our Human Resources Department at
HumanResources@EnsemblepHP.com
. This department will make sure you get connected to a Human Resources representative that can assist you.
EEO is the Law
FMLA Rights - English
La FMLA Español
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