Position Summary

This position facilitates modifications to clinical documentation through extensive concurrent interaction with physicians, nursing staff, other patient caregivers, and HIM coding staff to support that appropriate reimbursement and clinical severity is captured for the level of service rendered to all patients. This position reviews inpatient medical records while patients are still in-house for proper documentation; includes new admissions to the facility, as well as re-reviews periodically until the patient is discharged and is responsible for communication with clinicians and physicians to ensure timely and accurate documentation. This position provides training and education as needed. Individual will be responsible for the review of payer denials and participation in the appeal of clinical validation denials. This position receives regular supervision of work activities from the Mgr, Coding Compliance & CDI and does not provide direct supervision.

Education

• Bachelors degree in Nursing or Associates degree in Nursing coupled with 3 years clinical experience or CCDS, CDIP, RHIA, RHIT, or CCS certification in lieu of ADN or BSN. (Required)
• Masters degree in Nursing or Health Sciences. (Preferred)

Experience

• Minimum of (3) years of broad clinical experience, care coordination, case management, discharge planning, utilization review or acute care coding experience. (Required)
• Working knowledge of the financial aspects of third party payers and reimbursement. (Required)
• Experience in all areas of pediatric medicine inclusive of NICU and Behavioral Health (Preferred)
• Milliman criteria knowledge (Preferred)

Certifications

• Currently hold at least 1 role-related certification (AZ RN License or from a Compact state, CCDS, CDIP, RHIA, RHIT or CCS) (Required)

Special Skills

• Requires effective and positive human relations skills, including confidentiality, in order to appropriately interface with all levels of Phoenix Children’s Hospital staff, physicians, patients and their families, and other contacts. (Required)
• Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, influential leadership skill. (Required)
• Demonstrated effective critical thinking skills (Required)
• Moderate to expert computer skills (Required)
• Excellent communication skills, both verbal and written (Required)

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About Phoenix Children's

For more information about the hospital, visit: http://www.phoenixchildrens.org.

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