Remote Inpatient Clinical Appeal Specialist DRG (RN/APRN) in New Haven, CT

Remote Inpatient Clinical Appeal Specialist DRG (RN/APRN) - Yale New Haven Health - New Haven, CT - work from home job

Company: Yale New Haven Health

Job description: Job Description:



Overview



To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.



The Inpatient DRG Clinical Appeal Specialist supports the organization by providing expert clinical insight and participating in the process of developing and submitting Inpatient DRG Appeals.



EEO/AA/Disability/Veteran

Responsibilities



1. Collaborate with Coding and CDI Educator to provide educational opportunities derived from common themes

discovered through the appeal process in an effort to prevent future denials .

2. Track key denial data as they relate to departmental metrics and performance. Develop and maintain key

metrics report including the identification of trends, action plans, etc. Attend organizational committees to

present data as required.

3. Collaborate with Physician Advisors and the CDI Educator to resolve documentation discrepancies and

clinical disparities, escalation of clinical and coding issues and physician education.

4. Communicate directly with payer and coordinate meetings with contracting and payers as needed to support

appeals process.

5.

6. Coordinate Peer to Peer appeal reviews as needed.

7. Perform other duties as assigned.

Qualifications



EDUCATION:

Registered Nurse or Advanced Practice Nurse Practitioner with active license required. Bachelor's Degree in Nursing preferred. Certified Clinical Documentation Specialist (CCDS) certification required. Certified Coding Specialist (CCS) certification preferred.



EXPERIENCE:

3+ years Clinical Documentation Improvement or Inpatient Coding experience.



SPECIAL SKILLS: This position will advise Coding and CDI staff on the denials and appeals process, findings and educate on improvement initiatives. This position will provide guidance and education to physicians on documentation standards as they related to regulatory coding compliance. Collaborate with physician advisors and physician champions on clinical escalation as needed. Ability to analyze, produce and present high level analysis and metrics; Computer Skills to include all components of Microsoft Office Suite; Research skills; Project management; Educational

platform development and presentation; Teamwork; Ability to present coding and clinical information in a professional

and respectful manner. Demonstrate understanding of ICD-10-CM/PCS coding, MS-DRG and APR-DRG

methodology and validation.



ACCOUNTABILITY:

Maintain current knowledge of trends, regulations and technology related to documentation, coding, reimbursement and regulatory guidelines through professional journals, informal networks, internet sites and local, state, and national professional associations. Collaboration and communication with Clinical Documentation Improvement Physician Advisors, Coding and CDI staff, CDI Educator and Revenue Department staff. Educating and advising on DRG related findings as relating to the denials and appeals process.



COMPLEXITY:

In personal and job-related decisions and actions, consistently demonstrates the values of integrity (doing the right

thing), patient-centered (putting patients and families first), respect (valuing all people and embracing all differences),

accountability (being responsible and taking action), and compassion (being empathetic).

Provides a highly skilled resource to perform a clinical perspective review for MS-DRG and APR-DRG payer denials and

assist clinically through the appeal process. Provides a key resource group to perform specialized documentation and

clinical review of same. High financial impact in payer denials. Understanding and knowledge of clinical indications of

disease and peer-reviewed, evidenced-based criteria. Ability to perform high level research for clinical support references

to be provided. Demonstrate an understanding of complications, co-morbidities, severity of illness, risk of mortality, risk

adjustment factors, case mix index, secondary diagnoses and coding guidelines , and an ability to impart this

knowledge to staff, payers, physicians and other members of the healthcare team.



LICENSURE/CERTIFICATION:

Registered Nurse or Advanced Practice Nurse Practitioner license required. Certified Clinical Documentation Specialist (CCDS) certification required. Certified Coding Specialist (CCS) certification preferred.

YNHHS Requisition ID



92021
Remote Inpatient Clinical Appeal Specialist DRG (RN/APRN) - Yale New Haven Health - New Haven, CT - work from home job

Expected salary:

Location: New Haven, CT
Remote Inpatient Clinical Appeal Specialist DRG (RN/APRN) - Yale New Haven Health - New Haven, CT - work from home job

Job date: Sat, 08 Jul 2023 05:21:40 GMT

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Remote Inpatient Clinical Appeal Specialist DRG (RN/APRN) - Yale New Haven Health - New Haven, CT - work from home job

 

 

 

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