Overview:
This position is responsible for reviewing content of the medical record and assisting in the clarification of any documentation ambiguities noted. Collaborate with providers, coders, and other healthcare team members to facilitate comprehensive health record documentation that reflects clinical treatment, decisions, diagnoses, and intervention.

PREFERRED QUALIFICATIONS

• Experience with clinical documentation programs, use of electronic health record and coding preferred.
• Demonstrated knowledge of quality improvement theory and practice, core measures, safety and other required reporting programs.
• Additional related education and/or experience preferred.
  Foundation Health Partners is an EEO/AAP employer; qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status

• Provides subject matter expertise related to DRG, clinical documentation opportunities and requirements. Serves as an essential member of the clinical team, emphasizing their role in reviewing content of the medical record, assisting in the clarification of documentation ambiguities. Serves as the liaison between coding and physicians to explain, educate and assist in the needed documentation requirements to accurate conversion from the “clinical language” to the needed “coding language” in order to capture revenue, and for ensuring documentation accuracy.
• Conducts accurate and timely concurrent record reviews, recognizing opportunities for documentation improvement through specialized training and software. Utilizes available resources to formulate clinically credible “documentation clarification questions” for members of the clinical team aimed at improving the accuracy of the documentation process which is followed by effective and appropriate communication with physicians and timely follow up on all cases.
• Ensures data integrity of the clinical documentation database through compliant, accurate and appropriate entries. These include, but are not limited to, accurate input of case data, correct assignment of documentation clarification types and provider responses. Thus, ensuring precise case reconciliation with correct DRG & SOI/ROM shifts, HCCs, and complete E/O documentation.
• Gathers and analyzes information pertinent to documentation findings and outcomes. Identifies patterns, trends variances and opportunities to improve documentation review processes.
• Educates customers and creates presentations and/or reports for clinicians and facility management on clinical documentation opportunities, coding and reimbursement issues.
• Participates on hospital and departmental committees and assigned task forces, including denials, quality and E/O data review