Responsibilities
- Perform concurrent reviews of inpatient charts (primarily Medicare) to assess physician documentation and its impact on the Diagnosis-Related Group (DRG) and Case Mix Index (CMI).
- Collaborate with physicians, case managers, and coding staff to identify clinical documentation improvement opportunities and optimize DRG capture.
- Ensure physician documentation aligns with Inpatient Prospective Payment System (IPPS) criteria, eliminating payment errors, and maintaining compliance with Joint Commission (JCAHO) and federal/state regulations.
- Provide ongoing education, training, and in-services to physicians, residents, and interdisciplinary care teams on coding guidelines, DRGs, and documentation best practices.
- Track, trend, and compile objective data on CMI impact, producing analytical reports using Microsoft Excel.
- Assist with the compliance, abstraction, and documentation capture for JCAHO Core Measures
Required Skills
- Education & Licensure: Active Licensed Registered Nurse (RN).
- Certification: Certified Clinical Documentation Specialist (CCDS) credentials.
- EHR & Technical Systems: Direct hands-on experience using Epic EHR and 3M 360 Encompass (Solventum) coding software.
- Experience: Minimum of 5 years of experience in clinical documentation improvement (CDI), case management, or healthcare coding.
- Knowledge Base: Deep understanding of inpatient DRGs, IPPS criteria, and coding guidelines.
- Data Proficiency: Strong computer skills, specifically in data analysis using Microsoft Excel.
- Eligible Candidate States: Must reside in CT, NY, or NJ
Preferred Skills
- Bachelor’s Degree in Nursing (BSN) or a related field.
- Additional coding credentials (CCS, CCA, or CPC-H).
- Background or working knowledge in medical coding.
Schedule/Shift
- Status: Full-Time, FLSA Exempt.
- Hours: 8:00 AM to 4:00 PM, Monday through Friday.
- Weekends: Requires participation in a rotating weekend schedule.
- Location: On-site at the main inpatient hospital plaza facility.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.