Work Shift
Day/Evening
Scheduled Weekly Hours
40
Summary
This position supports Mercy's philosophy of patient centered care by ensuring the patient's medical record is an accurate reflection of their medical condition and the services provided by Mercy Medical Center.
Job Description
Job Duties
- Reviews medical records to identify documentation opportunities.
- Communicates with physicians regarding documentation issues to ensure immediate resolution.
- Educates physicians and caregivers on the importance of complete and accurate clinical documentation as it is related to patient acuity, severity of illness, physician profiling and core measures.
- Assesses improvement in the quality of clinical documentation for area of responsibility.
- Adheres to all federal, state and Mercy Medical Center policies relating to medical records.
- Participates in meetings with physicians and other providers to discuss patient care documentation trends and improvement opportunities.
- Applies Medical Necessity criteria to determine payment eligibility.
- Gathers pertinent information regarding the claim/service that is being denied so that an appeal may be formulated and filed.
- Works closely with the out-patient areas of Mercy Medical Center and is a resource for them regarding their documentation needs in relation to the services they provide.
- Participates in providing education to physicians and other clinical staff.
- Participates in education and training of new CDS staff.
- Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries.
Department Specific Duties
Health Information Management
- Participates in concurrent quality reviews.
- Identifies and participates educational opportunities with providers and support staff.
- Utilizes CDI software effectively and efficiently to capture accurate and complete documentation.
- Assists with denials management related to medical necessity, quality and clinical validation denials.
- Collaborates with inpatient coding team for reconciliation of CDI coding DRG mismatch.
- Attends inpatient conference, rounding, shift change for collaboration with inpatient team.
Radiation Center
- Reviews all billing for proper coding documentation in the Hall Radiation Center/Hematology Oncology Clinic
- Reviews all completed charts for a final audit and works in conjuction with the insurance office.
- Reviews denied claims and completes corrective action with both the insurer and staff.
- Assists as needed with patients to resolve billing issues
- Ensures that all charges are accurately reported and exported to the billing system.
Knowledge, Skills and Abilities
- Proficient in Microsoft Office products.
- Proficient in operation of computer, calculator, filing systems, copy/fax machines and telephone system.
- Excellent interpersonal skills.
- Excellent written and verbal communication skills.
- Excellent public relations and human relations - exemplifies The Mercy Touch.
- Excellent organizational and time management skills.
- Critical thinking, problem solving, and attention to detail skills.
- Exhibits good judgement.
- Handles confidential information with discretion and diplomacy.
- Commitment to life-long learning, e.g. willingness to learn/upgrade skills related to duties.
- Flexibility and dependability, works well with a wide variety of individuals and leadership styles.
- Ability to work with minimal to no supervision.
- Knowledge of Medicare Part A.
- Familiar with Medicare Part B.
- Knowledge of regulatory environment.
- Understand and communicate differences between Medicare Part A and Part B Guidelines.
Professional Experience
Health Information Management
- Required: Minimum two years acute care or equivalent clinical setting experience.
- Preferred: Knowledge of CPT and current ICD codes. Experience in critical care.
Radiation Center
- Required: Minimum 2-3 years acute care or equivalent clinical setting experience. Minimum 2 years of experience in billing and or auditing of medical records required.
- Preferred: Knowledge of CPT and ICD codes. Experience in radiation oncology department.
Education
Education sufficient to obtain licensure.
Licensure, Certification, Registration
Health Information Management
- Required: Maintain current Registered Nurse licensure in the State of Iowa.
- Required: Certification as Clinical Documentation Specialist within three years of hire or transfer.
Radiation Center
- Required: Maintain current Registered Nurse or Radiation Tech licensure in the State of Iowa.
- Preferred: Certification as a Clinical Documentation Specialist.
Pay Rate Type
Salary
Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years.
Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics.