Provides concurrent review of the clinical documentation in the medical records. Queries the medical staff and other caregivers as necessary via written/verbal communication to obtain accurate and complete physician documentation that supports the severity of patient illness and risk of mortality. Performs a thorough chart review to identify co morbidities/complications, and documents these appropriately on the DRG worksheet. Demonstrates creativity and enthusiasm while pursuing the goals of the department and the organization. Maintains the ability to be flexible, and prioritizes daily responsibilities. Collaborates with physician, physician extender, nurse, case manager/utilization reviewer and Medical Records coder to identify principal diagnosis options, secondary diagnoses and procedures, to assign working DRGs for at least 85% of identified populations. Able to utilize inpatient admission criteria to assign only diagnoses that meet acute care criteria. In the event that diagnosis does not meet admission criteria, communicates with appropriate staff regarding site of service. Conducts initial and extended-stay concurrent reviews on all selected admissions, and documents findings on DRG worksheets, denoting all key information utilized in the tracking process. Identifies need to clarify documentation in records, and utilizes strong communication skills with physician, physician extender, case manager, utilization reviewer, nurse or other healthcare professionals, utilizing appropriate tools to capture needed documentation. Works collaboratively with the healthcare team to facilitate documentation within the medical record that supports the accurate patient's severity of illness and risk of mortality. Utilizes monitoring tools to track the progress of the DRG Assurance program, through interpretation of on-site reports, monitoring reports and data. Shares findings with identified staff during DRG Assurance meetings. Able to identify areas of focus through report analysis. Serves as a resource to physicians and administration regarding issues related to the appropriateness of inpatient DRG assignment. Strong broad-based clinical knowledge and understanding of pathology/physiology. Knowledge of age-specific needs and the elements of disease processes and related procedures.
Bachelor's Degree in Nursing, Health Information Management or related field preferred.
Current licensure in the State of Illinois as a RN, RHIA or RHIT.
Minimum three (3) years of clinical experience in an acute care setting required Experience in Case Management, Utilization Review, ICD-9 Coding preferred Excellent written, verbal and critical thinking skills. Assertive personality traits to facilitate ongoing physician communication. Working knowledge of inpatient admission criteria. Ability to work independently in a time-oriented environment. Computer literacy and familiarity with operation of basic office equipment. Ability to perform responsibilities of the job.