Clinical Documentation Specialist
Responsible for optimizing internal controls. Review and edit Medicare Managed clinical
documentation to ensure compliance based on program specification for services, coding
accuracy, and revenue authorization. Optimize efficiencies and ensure positive patient
outcomes by achieving metric goals via auditing standards. Key metric goals include process
measures, case mix, episodes per admission, budgeted utilization, quality outcomes, LUPA's,
and telemedicine utilization.
Must be Cultural and Linguistic competent, Bilingual a plus; Haitian Creole, Portuguese Creole,
Spanish, Vietnamese, Chinese or Cambodian
POSITION RESPONSIBILITIES AND TASKS:
- Auditing record and training staff on compliance measure and create training materials
- Assist in training and development of new and ongoing staff in MA, NC, FL
- Provides clinically based concurrent review of outpatient medical records to assess and procure accurate and complete documentation of the patients' diagnoses and procedures.
- Ensures documentation accurately reflects the quality of care, the severity of illness and risk of morality to support correct coding, reimbursement, and quality initiatives.
- Works in collaboration with all departments.
- All tasks need to be performed following the Operating Principles of Lamour Clinic.
- Adheres to the system and department compliance policies, and any applicable laws and regulations. Performs other duties as assigned.
- Keep Program Director informed of potential and/or actual problems identified during the review process, concurrent progress and operation of the program.
- Perform initial case reviews, follow up reviews and queries based on program standards
- Has a strong working knowledge of patient safety indicators, healthcare regulations, reimbursement and documentation requirements.
- Maintains professional competency by keeping abreast of new changes within the industry including coding clinics, advancements in medical treatment, and guidelines.
KEY SKILLS & BEHAVIOR:
- Experience working in a fast-paced environment
- Good verbal, written and interpersonal communication skills.
- Knowledge of document control policies and practices.
- Ability to learn new software/systems quickly
- Excellent computer skills
- Highly adaptable and detail orientated
- Work well within a team
- Have an outstanding work ethic.
Location: Randolph, Massachusetts
Job Type: Full-time
Age group: All ages
QUALIFICATION REQUIRED AND EXPERIENCE:
- Bachelor’s degree or equivalent clinical education
- Experience as an archivist or documentation specialist, preferably in a biotech, pharmaceutical, or healthcare environment, with 1 year of experience BS or a BA, or pursuing of experience with MS or MA OR be willing to be trained
- Current clinical license in Massachusetts required
- Thorough knowledge of Medicare Conditions of Participation
- Strong computer skills and ability to learn various software packages
- Detail-oriented skills with the ability to organize and prioritize workload
- Previously demonstrated ability to achieve results by holding self-accountable
- Strong written, verbal and electronic communications skills.
- Ability to work with and positively influence a variety of personalities and diverse work-styles