Under direction, audit components of the clinical documentation improvement program and evaluate the multiple intersection points between functions and stakeholders. Understand and apply quality and quantity standards and assess all aspects of the program including data entry, data element capture and collection, process flow characteristics, program metrics, and behavior changes. Advise the coding staff regarding the determination of the correct principal diagnosis, identification of co-morbidities and complications, major co-morbidities and complications, secondary diagnoses, and principal and secondary procedures performed in a hospital environment. Use industry criteria and clinical knowledge to determine, explain, support or rebut coding changes and scores in writing appeals to payers associated with denied or revised encounters.
Conducts audits to ensure accurate and complete data for the clinical documentation improvement program.
Identify corrective action workflow improvements, data integrity opportunities, and training topics.
Reviews medical records to determine accurate coding and support clinical documentation.
Tracks trends, reports findings and facilitates change process.
Identifies knowledge gaps and provides clear explanations on missing, unclear, conflicting or noncompliant information.
Reviews technical payer denials and determines if an appeal is justified and performs prospective third party payor reviews.
Assigns the codes that reflect the occurrence of events, severity of illness, and resources utilized.
Reviews documentation to ensure assigned codes are supported and recognizes improvement opportunities.
Organizational Impact: Delivers projects/assignments that have a direct impact on goals/objectives of the unit/department that the job is in.
Problem Solving/ Complexity of work: Conducts extensive analysis of situations or data to resolve numerous, complex issues; may involve the input/work of others.
Breadth of Knowledge: Has in-depth level of knowledge within a professional area and working knowledge of other areas.
Team Interaction: May lead mid-sized projects; coaches and guides team members.
Graduate of an approved discipline specific program (or equivalent experience) and 7 years relevant experience
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period.
Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties.
Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disea...se.
As the largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.
Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.