Clinical Documentation Improvement Specialist (Remote) - Healthcare Re
Clinical Documentation Improvement Specialist (Remote) - Healthcare Re
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Clinical Documentation Improvement Specialist (Remote) Resume


Desired Industry: Healthcare SpiderID: 81942
Desired Job Location: Pisgah, Alabama Date Posted: 4/8/2019
Type of Position: Full-Time Permanent Availability Date:
Desired Wage: 90000
U.S. Work Authorization: Yes
Job Level: Management (Manager, Director) Willing to Travel: No
Highest Degree Attained: Masters Willing to Relocate: No


Objective:
Motivated, detail-oriented and performance-focused professional, with progressive background in performing day-to-day documentation operations and providing concurrent and discharge reviews. Knowledgeable of clinical documentation and query process for complete and quality patient health records. Equipped with outstanding communication and interpersonal aptitudes in establishing positive relationships with diverse healthcare professionals. Technically proficient with 3M 360 Encompass, Cerner, JATA, Skype and Microsoft Office (Word, PowerPoint and Excel).


Experience:
Trust Healthcare Consulting Services, LLC | Springfield, MO
Registered Nurse Clinical Documentation Consultant 2018–Present
Take charge of adding new accounts to the complete list for review as well as prepare queries when needed while generating a diagnosis-related group (DRG) through 3M 360 Encompass
Hold responsibility for appropriately utilizing Cerner clinical documentation improvement (CDI) computer program with embedded JATA for working and possible DRG
Formulate DRG, severity of illness (SOI) and risk of mortality (ROM) changes and non-impact queries
Work on a remote assignment within a large teaching hospital
Regularly monitor patient account reviews using Excel spreadsheet
Conduct monthly rounds with the (CDI) manager
Complete new reviews before performing concurrent reviews and reconciling final coded charts; send email to providers to address queries and note query impact on accounts with financial difference
Communicate with medical doctors, assistants and mid-level practitioners on inquiries through phone calls and emails
Manage a complete list of initial, concurrent and discharge accounts, along with a non-reconciliation list of accounts awaiting final DRG assignment

DeKalb Regional Medical Center | Fort Payne, AL
Registered Nurse Clinical Documentation Specialist 2015–2018
Carried out all payer initial and concurrent chart reviews with designated ICD-10 codes
Utilized 3M 360 Encompass, hospital coding management system, and MEDHOST
Mentored physicians and nurse practitioners when needed
Held accountability for monthly query impact reports; handling DRG assignment for the Case Management Team
Prepared physician queries for possible changes in DRG, SOI and ROM
Coordinated closely with the case management director regarding DRG denials
Worked remotely every Wednesday
Provided education via PowerPoint presentations to clinicians

Career Highlight:
Successfully achieved a query rate at 25%, response rate at 90%, and agree rate at 90%

Registered Nurse Case Manager 2012–2015
Assumed responsibility for case management assessments of medical/surgical (M/S), cardiac, intensive care unit (ICU), obstetrics/gynecology (OB/GYN), pediatric and psychiatric clients
Referred accounts to internal and external physician advisor services when appropriate
Fostered relationships with multiple insurance providers and collaborated with the Healthcare Team to coordinate patient care
Initiated physician request for peer-to-peer insurance reviews and appeal letters for denial management
Utilization review for medical necessity of inpatient versus observation status

Riverview Regional Medical Center | Gadsden, AL
Registered Nurse Case Manager 2010–2012
Rendered case management assessments of medical, surgical and cardiac clients
Thoroughly assessed medical chart for medical necessity
Interacted with numerous health insurance companies and engaged with physician advisor services

Huntsville Hospital | Huntsville, AL
Case Management Practicum 2010
Cultivated interdisciplinary cooperation with health providers and medical insurance companies
Performed various assignments such as utilization review, case management assessments and patient discharge planning


Education:
Master of Science in Nursing in Case Management | University of Alabama  Tuscaloosa, AL
Capstone College of Nursing Departmental Grant
State of Alabama Nursing Student Scholarship

Bachelor of Science in Nursing | Jacksonville State University  Jacksonville, AL

Associate of Applied Science in Nursing | Northeast Alabama Community College  Rainsville, AL

Practical Nursing | J.F. Drake State Community and Technical College  Huntsville, AL

Associate of Arts | Chattanooga State Technical Community College  Chattanooga, TN
Academic/Athletic Scholarship


Affiliations:
Member, Association of Clinical Documentation Improvement Specialists (ACDIS)


Skills:
Quality Evaluation | Coding Compliance and Standards | Clinical Documentation Development and Collaboration
Medical Terminology | Account Management | Continuous Process Improvement


Additional Information:
Professional Development

Licenses:
Registered Nurse, States of Alabama, Georgia and Tennessee

Certification:
Certified Case Manager, Commission for Case Management Certification
Certified Clinical Documentation Specialist, Association of Clinical Documentation Improvement Specialists

Training:
HCPro Clinical Documentation Improvement Boot Camp
HMA Resource Management and Physician Advisor Annual Training (May 2011 and 2012)


Candidate Contact Information:
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