Chargemaster Clinical Document Specialist (Finance)

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The Chargemaster Clinical Documentation Specialist is responsible for activities which improve the accuracy of facility outpatient clinical documentation and charging, including education with the clinical departments and root cause correction to support accurate charging and coding in compliance with Hospital/Health System policies. The Chargemaster Clinical Documentation Specialist assists clinical areas to effectively document services and understand the relationship of documentation, medical necessity, and charging for the services provided in accordance with Hospital/Health System policies and procedures.Minimum Required: Associate of Science in Nursing (ASN). Preferred: Bachelor of Science in Nursing (BSN). | Required: Current RN License in Ohio. Certified Clinical Documentation Specialist-Outpatient (CCDS-O) or an equivalent certification. | Three or more years of healthcare knowledge typically obtained from experience as a clinical caregiver or manager, coding or charge capture specialist, and/or a revenue management/cycle professional staff person.Perform Audits:
• Conducts auditing and monitoring of assigned areas.
• Conducts regular chart reviews of assigned clinical departments to regularly review the documentation and charge accuracy and to integrate into educational sessions with the clinical departments and medical staff.
• Performs shadowing and coaching with key stakeholders in the clinical departments to facilitate adoption of best practices and improve documentation and charging accuracy.
• Documents and maintain clinical documentation audit results and data.
• Collaborates and partner with Internal Audit with their charge related audits in their annual audit program.

Clinical Documentation Outreach Education & Training:

• Provides reporting and feedback to the clinical departments based on claim accuracy and chart reviews to encourage greater understanding and ownership of documentation and charge accuracy.
• Works with revenue producing clinical department managers to develop and provide educational sessions for staff concerning issues identified through the auditing process.
• Present audit findings and assist in the development of constructive recommendations/education to clinical departments.
• Attends educational sessions, training sessions and task forces sessions as directed.
• Maintains current knowledge of applicable regulatory standards, which may impact on the utilization of processes and systems

Data Analysis/Financial Reporting:

• Performs analysis of patient clinical and billing data to identify documentation, coding, and charging opportunities, summarizes data, and prepares summary materials for discussion with clinical and/or finance teams.
• Performs review of accounts identified as potentially missing charges and conducts additional research to help resolve the areas of opportunity and identify the root cause of the issues causing the missed charges.
• Coordinates with clinical departments as well as Coding, PFS, CDM, Finance, and others to review and correct claims and identify and resolve root cause issues.
• Tracks, reports, and effectively communicate audit findings including reimbursement and compliance information.
• Works with finance to track revenue indicators and corresponding action plans.

Project Work/Process Improvement:

• Develops and maintains project plans and project tracking, including documentation of project meetings and project issues lists.
• Tracks, reports, and effectively communicate audit findings including reimbursement and compliance information.
• Reviews audit results with management and staff and consider feedback from the internal/external customers as appropriate.
• Takes ownership and initiative to build upon documentation and charge capture processes for identified areas of opportunity

Other duties as assigned:

• Provides occasional backup for other auditors or CDM team members.Perform Audits:
• Conducts auditing and monitoring of assigned areas.
• Conducts regular chart reviews of assigned clinical departments to regularly review the documentation and charge accuracy and to integrate into educational sessions with the clinical departments and medical staff.
• Performs shadowing and coaching with key stakeholders in the clinical departments to facilitate adoption of best practices and improve documentation and charging accuracy.
• Documents and maintain clinical documentation audit results and data.
• Collaborates and partner with Internal Audit with their charge related audits in their annual audit program.

Clinical Documentation Outreach Education & Training:

• Provides reporting and feedback to the clinical departments based on claim accuracy and chart reviews to encourage greater understanding and ownership of documentation and charge accuracy.
• Works with revenue producing clinical department managers to develop and provide educational sessions for staff concerning issues identified through the auditing process.
• Present audit findings and assist in the development of constructive recommendations/education to clinical departments.
• Attends educational sessions, training sessions and task forces sessions as directed.
• Maintains current knowledge of applicable regulatory standards, which may impact on the utilization of processes and systems

Data Analysis/Financial Reporting:

• Performs analysis of patient clinical and billing data to identify documentation, coding, and charging opportunities, summarizes data, and prepares summary materials for discussion with clinical and/or finance teams.
• Performs review of accounts identified as potentially missing charges and conducts additional research to help resolve the areas of opportunity and identify the root cause of the issues causing the missed charges.
• Coordinates with clinical departments as well as Coding, PFS, CDM, Finance, and others to review and correct claims and identify and resolve root cause issues.
• Tracks, reports, and effectively communicate audit findings including reimbursement and compliance information.
• Works with finance to track revenue indicators and corresponding action plans.

Project Work/Process Improvement:

• Develops and maintains project plans and project tracking, including documentation of project meetings and project issues lists.
• Tracks, reports, and effectively communicate audit findings including reimbursement and compliance information.
• Reviews audit results with management and staff and consider feedback from the internal/external customers as appropriate.
• Takes ownership and initiative to build upon documentation and charge capture processes for identified areas of opportunity

Other duties as assigned:

• Provides occasional backup for other auditors or CDM team members.