RN Clinical Documentation Specialist

Job Summary

A company is looking for a Clinical Documentation Specialist RN.

Key Responsibilities

• Conduct concurrent and retrospective reviews of inpatient medical records to assess documentation and utilization of acute care services
• Facilitate accurate physician documentation to reflect patient severity of illness and risk of mortality
• Ensure compliance with external payer and regulatory agency requirements for quality of care reporting and reimbursement accuracy

Required Qualifications

• Bachelor's degree in Nursing or Health Information Management, or equivalent education and experience
• Registered Nurse (RN) or Certified Coding Specialist (CCS) required; CCDS or CDIP preferred
• Minimum of 6 years of related experience, including clinical and inpatient case management or coding
• Knowledge of care delivery documentation systems and inpatient admission criteria
• Working knowledge of Medicare reimbursement systems and coding structures preferred