CLINICAL DOCUMENTATION INTEGRITY SPEC
Duke University

Durham, North Carolina


PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke’s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.

Duke Nursing Highlights:

  • Duke University Health System is designated as a Magnet organization
  • Nurses from each hospitalare consistently recognized each year as North Carolina's Great 100 Nurses.
  • Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
  • Duke University Health System has 6000 + registered nurses
  • Quality of Life: Living in the Triangle!
  • Relocation Assistance!

This position may have an opportunity to work remotely. All Duke University remote workers must reside in one of the following states or districts: Arizona; California; Florida; Georgia; Hawaii; Illinois; Maryland; Massachusetts; Montana; New Jersey; New York; North Carolina; Pennsylvania; South Carolina; Tennessee; Texas; Virginia or Washington, DC

Occ Summary

Communicates with and educates physicians, mid-level providers, patient resource managers/case managers, Hospital Information Management (HIM) Compliance Specialists, and other health team members to facilitate improvement in comprehensive and inpatient medical record documentation to reflect conditions present on admission, diagnoses, complications/ comorbidities (CCs) and the clinical treatment plan for inpatients. Work Performed Rounds with the physician team and completes a review of the medical record for all Medicare, Medicaid, and Self-Pay patients and create clinical documentation records. Communicates with physicians to clarify information, obtain needed documentation, present opportunities for improvement, and educate for appropriate Diagnosis Related Group (DRG) based on the verity of illness.

Follows up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with HIM to develop physician education strategies to promote complete and accurate clinical documentation and correct negative trends. Provideseducationsessionsto physicians/physician extenders. Demonstrates an understanding of CCs, severity of illness, risk of mortality, case mix, secondary diagnosis, and the impact of procedures on DRG, and can impart t his knowledge to physicians and other health team members. Utilizes the appropriate clinical documentation system to identify opportunities and ensure accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes. Assists with the completion of CDI Retrospectivedocumentation through meetings with physicians/clinicians for query response and or documentation clarification. Identifies the most appropriate principal diagnosis and CCs to accurately reflect the severity of illness.

Processes discharge by assigning and updating a working DRG and collaborates with HIM as necessary to ensure that the final DRG assignment is reflective of the optimal DRG which reflects resource allocation. Acts as a consultant to Hospital Information Management (HIM ) ComplianceSpecialists when additional information or documentation is needed to assign the correct DRG. When contacted by Hospital Information Management (HIM) ComplianceSpecialists concerning disagreements about DRG or incomplete documentation, reviews medical records and follow up with the physician, if appropriate, in a timely manner. Works with HospitalInformat ion Management (HIM)Compliance Specialists to ensure AR days remain in the targeted range.Review chart with CodingManager and/or immediate supervisor, if unable to reach an agreement with hospital information management (HIM) Compliance Specialists. Reviews inpatient medical records both concurrently and retrospectively for identified services and payer populations.

Reviews all Medicare/ Medicaid and Self-Payinpatients at the time of admission to verify the written admission order (IP, OBS, OPS) for accuracy in accordance with the Hospital#sUtilization Management Plan and takes appropriate action to ensure congruence and compliancewithDUH and federal regulations. Ensures that orders are reflective of thepatient#s level of care, the severity of illness, and intensity of service utilizing set criteria. Communicates and collaborates with DUHSbillingentity (PRMO), to ensure that all admission orders are written are accurately reflected in the billing system to ensure accuracy and congruence between the clinical and billing systems. Provides feedback via formal and informal education to physicians that will improve processes and compliance with a utilization management plan. Provides ongoing utilization review for private payors for identified vices i.e. inpatient psychiatry, and the pediatric and adult bone marrow transplant units. Collaborates effectively with reviewers from third-party payors to ensure positive working relationships and avoid denials for payment secondary to medical necessity or lack of information during the concurrent admission. Provides on-call support to the DUH Emergency Department (ED) to support the accuracy and timeliness of ED physicians. Support physicians/physician extenders in the determination and assignment of patient status. Provides education to ED physicians/physician extenders via informal and formal education sessions to ensure understanding of the patient status and to ensure compliance with the Utilization Management Plan Perform other related duties incidental to the work described herein. Knowledge, Skills, and Abilities Prior Case Management / Utilization Review experience and/or training in advanced communication and interpersonal skills with all levels of internal and external customers. Excellent written/verbal communication, critical thinking, creative problem solving, and conflict management skills. Proficient organization and planning skills. Strong computer skills. Demonstrated knowledge of quality improvement theory and practice.

Minimum Qualifications

Education

BSN or PA (Physician's Assistant) or NP (Nurse Practitioner) or Doctorate degree in a medically related field required.

Experience

Three years of progressive healthcare experience in an acute care setting. Previous chart review experience (case management utilization review) preferred. Excellent written/verbal communication, critical thinking, creative problem solving and conflict management skills in addition to proficient organization and planning skills required. Demonstrated knowledge of quality improvement theory and practice.

Degrees, Licensures, Certifications

Currently licensed and/or registered as a Professional Nurse/Physician Assistant/MD in the state of North Carolina, preferred. CCDS, CCS, or CDIP preferred.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.



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