Clinical Document Integrity Specialist Lead | Full time at UF Health

Gainesville, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Apr, 26

Salary

0.0

Posted On

25 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Documentation, Quality Review, Assessment, ICD-10 CM/PCS, Microsoft Office, Communication, Report Generation, Utilization Management, Case Management, Quality Improvement, Inpatient Coding, Self-Starter, Trend Identification, Process Refinement, Data Requests, Educational Development

Industry

Hospitals and Health Care

Description

Overview This position is responsible for ongoing quality review and assessment of inpatient hospital charts. Performs concurrent and retrospective second level reviews on specific types of opportunities and retrospective requests; cases could include low acuity discharges to hospice and mortalities, low acuity DRGs with long LOS, specific DRG opportunities based on analytics, etc. Prepare reports for management review and identify trends. Strategize approach and process refinements to capture opportunity within the CDS team (prioritization, assignment, etc.) based on retrospective requests and second level reviews. Serve as the main point of contact for external and internal CDI data requests. Under the direction of the Clinical Documentation Integrity Manager, he/she contributes to the development of educational and training opportunities for staff and other duties as assigned. Qualifications Minimum Education and Experience Requirements: Graduate of an accredited school of nursing with current RN licensure in the State of Florida or International Medical Graduate with Medical School Diploma required. Certified Clinical Documentation Specialist (CCDS) preferred certification. Minimum 5 years of recent clinical experience in a hospital setting. Utilization Management, Case Management, Quality Improvement or Inpatient Coding experience preferred. Must have strong knowledge of ICD-10 CM/PCS and proficiency with Microsoft Windows Operating Systems and Office applications such as Word, Excel, PowerPoint, and coding/grouping software. Able to work well with minimal supervision. Able to communicate clearly both written and verbally. Able to generate reports for management review that present audit results in a clear manner. Able to meet deadlines and respond well to frequent changes in regulation. Able to maintain positive and productive relationships with internal and external teams and customers. Able to work independently and be a self-starter. Motor Vehicle Operator Designation: Employees in this position: Will operate vehicles for an assigned business purpose as a “non-frequent driver” Licensure/Certification/Registration: Registered Nurse (RN) required or Medical School Diploma

Responsibilities

The Clinical Document Integrity Specialist Lead is responsible for ongoing quality review and assessment of inpatient hospital charts, performing concurrent and retrospective reviews. They also prepare reports for management and strategize process refinements within the CDS team.