Clinical Documentation Support Specialist

ROLE:  

The Clinical Documentation Support Specialist is responsible for the clinical review of medical record documentation to support compliance audits, organizational risk assessments, and ongoing monitoring activities. The Clinical Documentation Support Specialist ensures that clinical reviews are handled appropriately with the necessary level of urgency and attention to detail and in an efficient and effective manner.  Additionally, this position is responsible for routinely completing and coordinating clinical review related customer chart documentation trend analysis for outreach training and education opportunities as assigned.  

TASKS AND RESPONSIBILITIES:

• Completes patient medical record reviews to support compliance audits, organizational risk assessments, and ongoing monitoring activities.
• Responsible for reviewing and determining that supporting documentation demonstrates performance of medically necessary services.
• Supports random and focused pre-payment and post payment audits in the review of patient medical records.
• Completes medical record reviews in a timely manner.  
• Assists to ensure all possible efforts are made to obtain appropriate internal and external patient medical record documentation to support the services provided and billed. 
• Supports the tracking of medical documentation received, outbound requests, and ensures all necessary information is obtained (where they exist). 
• Follows related policies and procedures and escalates where appropriate.
• Assists in medical review related customer chart documentation trend analysis for outreach training and education opportunities.
• Ensures all reasonable efforts are made to obtain appropriate external medical record documentation to support the services in question. 
• Ensures medical record documentation received is recorded appropriately and aids in the management of outbound documentation requests.   
• Assists Senior Clinical Specialist with other areas of responsibility as requested.

QUALIFICATIONS:

• Excellent knowledge of medical terminology and clinical documentation.
• Strong oral, written and interpersonal communication skills.
• Excellent organizational and attention to detail skills required.
• Able to effectively prioritize, research, trouble-shoot, and problem solve. 
• Must have ability to manage multiple and competing priorities.
• Team player who is able to prioritize, work well under pressure, readily adapt to change, and excel in a productivity based environment.
• Ability to concentrate on highly detailed work despite frequent interruptions and work effectively with minimal supervision.

EDUCATION/EXPERIENCE:

• Bachelor’s degree required.
• Five years or more related experience may substitute for bachelor’s degree.
• Experience in medical terminology and documentation review is preferred.
• Experience with healthcare billing system solutions and Microsoft Office required.
• Experience with government and other third party payers required.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to stand; to handle or feel; to talk and to hear.  The employee is occasionally required to walk, sit, reach with hands and arms and stoop, kneel, crouch or crawl.  The employee must occasionally lift and or move up to 15 pounds.  Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT:

Standard office environment.