Governance, Risk, Compliance Manager
Fragomen
Compliance Documentation Improvement Specialist, RN
Advocate Aurora Health
full-time
Posted on:
Location: North Carolina • 🇺🇸 United States
Visit company websiteSalary
💰 $38 - $56 per hour
Job Level
Mid-LevelSenior
About the role
- Reviews selected populations of inpatient medical records to identify the principal and/or secondary diagnoses.
- Appropriately assigns the MS-DRG that most accurately reflects the severity of illness of the patient based upon the clinical evidence documented at the time of the record review.
- Demonstrates knowledge and understanding of severity based DRG systems; All Patient Refined and Medicare Severity (AP-DRG) and Medical Severity Diagnostic Related Group System (MS-DRG).
- Demonstrates the ability to utilize the licensed software tool to perform and record daily medical record reviews.
- Interacts with the physician and/or other designated members of the healthcare team to ensure that vague or incomplete documentation is clarified within the medical record in a timely manner.
- Works with other departments such as coding, corporate compliance, quality, and finance to support Corporate Goals.
- Participates in the ongoing education of physicians, nurse practitioners, physician assistants and other healthcare team members to identify medical record documentation improvement opportunities employing conflict resolution skills as necessary.
- Utilizes critical thinking skills based upon extensive knowledge of disease processes and clinical outcomes to identify the need for further clarification of physician documentation within the medical record.
- Ensures that all written requests to physicians for additional documentation support Corporate Compliance policies.
Requirements
- Registered Nurse applicable state Licensure required.
- Bachelor's Degree Required.
- Appropriate professional certification required within 3 years of hire date per department protocol.
- 5 years of related nursing experience preferred.
- Clinical experience within the assigned population.
- Extensive knowledge of disease processes and clinical outcomes.
- Case Management experience or background helpful.
- Strong financial and analytical skills preferred.
- Word, Outlook, Excel experience preferred.
- Ability to speak English fluently and write in understandable terms.
