Quality Clinical Documentation Improvement RN

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings. Our Mission As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values.

Job Summary and Responsibilities ***This position is work from home within California. Position Summary: The Quality Clinical Documentation Improvement (QCDI) RN is responsible for performing a comprehensive review of ambulatory medical records to confirm documentation compliance with the Centers for Medicare and Medicaid Services (CMS) programs and other quality initiative programs Dignity health Medical Foundation participates in. The primary focus of the QCDI RN position is to review provider documentation, provide education to providers, and review trends of assigned providers or medical groups. Additionally, the QCDI RN will provide guidance to Reimbursement staff in their day-to-day chart reviews.

Reviews high volume of EMR medical records to determine if specific conditions were assessed and documented appropriately; Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures Identifies claims correction opportunities and submit to appropriate personnel for processing in a timely manner within pre-set acceptable accuracy levels. Tracks trends for each physician to identify potential training areas. Maintains accurate, timely tracking of physician documentation performance using established tools within the department; Alerts management when low performance trends occur. Participates with third-party collaborator to identify trends and to address and resolve gaps in performance standards. Provides chart review guidance and education to team regarding appropriate chart review methodology when necessary; Performs secondary chart reviews when applicable to clarify compliance to coding guidelines.