Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.
No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.
General Summary
- The Professional Fee Clinical Documentation Specialist (CDS) will serve as an advisor and expert resource for providers to improve the accuracy of clinical documentation to support patient complexity, risk profiles and appropriate E/M levels thereby supporting the provider’s efforts and their professional fee billing.
- The CDS primarily assists providers in identifying clinically relevant information and capturing the clinical documentation needed to accurately reflect patient acuity. The Professional Fee CDS will focus on the recapture and identification of chronic conditions reflected in Hierarchical Condition Categories (HCCs), which directly impact the patient risk adjusted profile (RAF score) calculated by the associated risk plans. They will also assist with highlighting opportunities based on the provider’s medical decision making to appropriately reflect the level of service provided for patient care.
Essential Duties and Responsibilities
- The Professional Fee CDS will be responsible for completing pre-visit and post-claim reviews as well as providing clear communication and education to providers on their documentation, coding and billing practices, in adherence to compliance standards set by governing entities such as CMS, AHA, etc.
- Pre-visit reviews are intended to identify documentation opportunities for the provider to recapture previously documented HCCs diagnoses, or new “suspect conditions” not previously captured that are identified by the CDS’s comprehensive chart reviews. These efforts assist in establishing accurate risk profiles and related health care costs
- Post-claim reviews focus on E/M encounters and highlight opportunities based on a provider’s medical decision making and the patient’s acuity to support appropriate and accurate E/M level assignments as well as any HCCs identified
- Applies a “clinical detective” mindset to identify new HCC diagnosis capture opportunities based on appropriate clinical indicators for the patient.
- The Professional Fee CDS will also coordinate with colleagues from the CDI Program or other members of the organization regarding education and training geared towards improving clinical documentation based on findings from pre-visit and post-claim reviews
- Uses performance and outcome data from third-party support or other sources to identify high priority providers
- Creates specialty-specific education on relevant topics as identified in data analytics and from clinical encounter reviews and post-claim education chart reviews
- Develops and maintains a systematic education schedule and approach for providers in the hospital and clinic/office setting including but not limited to complete documentation, appropriate diagnosis code selection, E/M level assignments and updates to coding guidelines.
- Delivers ongoing feedback and education to communicate importance of complete documentation and key concepts during regular clinic or provider meetings or on individual basis, as needed
Education
- Minimum associate degree
- Licensure / Certification: CCS-P, CPC, CRC, CCDS or other coding credential required
RN or LPN preferred
Work Experience
- Three (3) years’ experience in hospital or outpatient healthcare setting, preferred.
- Coding experience highly preferred.
- Extensive clinical knowledge and understanding of pathophysiology
- Strong critical thinking skills and utilization of clinical knowledge to identify potential clinical indicators supporting patient acuity and clarifications of the medical record
- Excellent written and verbal communication skills
- Possesses strong project management skills
- Possesses strong interpersonal skills, with demonstrated success at communicating effectively with all levels of the organization
- Demonstrates skilled ability and comfort with electronic medical records (Epic preferred)
- Proficient with personal computer applications (Excel, Word, and Power Point)
Mental/Physical Requirements
- Considerable mental concentration required to complete duties. Sitting or transporting self throughout facility 90% of time. Light lifting, up to 15 lbs., is required. Requires working at a computer terminal. Requires the ability to be flexible, organized and function under stressful situations.
Working Conditions
- The working conditions may include, but not limited to; potential exposure to infectious disease, slight possibility of exposure to radiation, anti-neoplastic agents, hostile persons, minimal physical discomfort, and frequent auditory distractions.
At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself! Apply now to join us on our mission in health care.