Job Description

Job Description

LOCATION:  WICKENBURG, AZ

Wickenburg Community Hospital is a beautiful and sophisticated rural-access hospital located in Wickenburg, Arizona.  WCH is a 8-bed Emergency Department, 19-bed Acute department and many ancillary services.  We also have 3 Primary Care Clinics.  Here at WCH, we strive to maintain the highest standards of professionalism and care.  Join us today and let us be part of your success story.

We offer:

• Full Benefits
• PTO/Sick Leave
• Wellness Benefits

Wickenburg Community Hospital is a non-profit organization and qualifies for the Public Service Loan Forgiveness (PSLF) program.

General Description 

The Clinical Documentation Specialist/Utilization Review Registered Nurse collaborates extensively with physicians, nursing staff, coding staff and billing staff to

• Improve the quality and completeness of documentation of care provided at our hospital and clinics.
• Queries and educates medical and clinical staff.
• Conducts focused chart reviews and documentation audits.
• Works with providers to improve documentation to meet measure goals.
• Is a resource to other staff focused in Charge Capture duties. 

Essential Job Duties 

• Collaborates directly with the appropriate Departmental Director regarding documentation and coding process.
• Focuses on real time documentation opportunities to enhance charge capture and reimbursement.
• Builds and generates reports from the EMR.
• Review medical records for compliance including completeness and accuracy for severity of illness and quality.
• Complete accurate and timely record review to ensure the integrity of documentation compliance.
• Understands and supports documentation strategies related to EMR and continues to educate self and revenue cycle team members.
• Recognizes that documentation drives charge capture and will work diligently with all clinical team members to support charge capture initiatives.
• Perform charge capture studies to identify areas of improvement and work with clinical department leads to facilitate resolution and on-going charge capture.
• Recognizes opportunities for documentation improvement using strong critical-thinking skills. Uses critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance.
• Works effectively with insurance companies including Medicare and Medicare Advantage plans, AHCCCS, and Commercial plans.
• Assures that denials are quickly addressed and supporting clinical evidence is prepared and sent in a timely fashion.
• Coordinates Peer to Peer appeals between the WCH provider and the Insurance carrier.
• Oversees the provider routine peer to peer process.
• Oversees the Utilization Review Process ensuring regular meetings are being completed, meeting notes are being logged, and is responsible for assuring the appropriate use of resources and facilitating the patient's progression through the continuum of care in a timely and cost-effective manner.
• Oversees the admission qualifier process (MCG) and staff education. Responsible for determining the appropriateness of hospital admissions and medical necessity for continued stay, assuring medical documentation accurately reflects the severity of illness and acuity of the patient.
• Maintains proficiency in clinical criteria, evidence-based practice, regulatory compliance, reimbursement sources, and the health care delivery system.
• Strategically educate members of the patient care team regarding documentation regulations and guidelines, including attending physicians, allied health practitioners, nursing and care management. This includes compliance updates from Medicare.
• Effectively and appropriately communicate with physicians and other healthcare providers as necessary to ensure appropriate, accurate and complete clinical documentation. Communicates with other HIM staff and collaborates with them to resolve discrepancies with DRG assignments and other coding issues.
• Complete well-timed follow-up case reviews on all concurrent cases with priority given for resolution of those with clinical documentation clarifications.
• Will stay abreast of the regulations regarding documentation requirements and actively engage in continuing education and training WCH staff accordingly.
  Is a resource to other staff focused on Charge Capture duties.

Other (Non Essential) Job Duties 

• Actively participate in meetings, including presentations for educational opportunities.
• Will participate in various committees across the organization such as peer review committee and utilization review committee.
• All other duties as assigned

Minimum Qualifications 

• Current license to practice nursing in the State of Arizona
• Prior experience in CDI, UR/UM, discharge planning, quality management, case management or coding.
• Advanced computer skills and spreadsheet utilization.
• Excellent written and verbal communication skills.
• Demonstrates basic knowledge regarding HIM coding standards.
• Analytic skills necessary to accurately assess patient medical records.
• Excellent interpersonal skills and ability to work on a team to influence change.

Preferred Qualifications 

• Certification in clinical documentation through either AAPC or AHIMA, or ability to obtain within 1 year of hire.
• Coding certification from either AHIMA or AAPC.
• 3-5 years recent experience in an acute care hospital setting preferred.

Physical Requirements/Working Conditions 

• Must be able to sit for long periods
• Must be able to operate standard office equipment
• Must be able to lift and carry up to 20 lbs
• Must be able to work paying close attention to detail with frequent interruptions.
• Ability to work in a fast pace environment.
• Adequate hearing and vision for effective communication.
• Follow complex instructions.
• Think logically in following procedures and instructions.
• Work well under stress, with interruptions and deadlines.
• Effectively communicate dept needs to other departments.

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