PRN LVN Clinical Reviewer
This position is responsible for conducting and analyzing data collected for patterns and trends to identify opportunities to improve documentation and coding for providers. Responsible for reviewing inpatient and outpatient hospital records, and outpatient physician records for the purpose of identifying and submitting documented diagnoses to CMS for client members of Medicare Advantage plans. The position interacts with a variety of internal and external clients including physicians, provider office personnel and billing staff. This position requires high level interpersonal skills.
• Perform chart audits in hospital records by reviewing clinical documentation against supporting information in the medical record, claims data and coding information.
• Participate in Case Conferences to help identify high risk members and assess the needs of the member for Risk Adjustment, Quality gaps, and cost control.
• Identify any chronic conditions coded in the previous year and make recommendations for the current year and review labs, x-rays, pathology and other various reports to identify suspected conditions and make suggestions for new code captures.
• Identify opportunities; provide guidance and suggestions for quality and performance improvements in the collection and recording of clinical documentation.
• Special projects as needed.
• Be in line with all company goals and policies.
• Analyze data collected for patterns and trends to identify opportunities to improve documentation.
• Record findings completely and accurately in accordance with ICD-9 and ICD-10 coding guidelines.
• Additional duties assigned by supervisor
• Current Licensed Vocational Nurse License
• CPC, or CCS License
• 5-8 years’ experience of coding experience in an outpatient or inpatient setting
• Strong knowledge of ICD-9 and ICD-10 coding guidelines
• Ability to work independently in a fast paced environment
• Must be proficient in use of Microsoft tools and technology
• Working knowledge of Medicare risk adjustment and health plan quality measures preferred
• Critical thinking skills and ability to work with minimal supervision
• Assertive and excellent communication skills
Skills or Special Abilities:
• Self Confidence
• Ability to Multitask
• Organization Skills
• Time Management
• Communication Skills
• Attention to Detail
• Customer Relations
• Problem Solving
• Favorable Disposition
• Calm Demeanor
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to frequently sit, use finger dexterity, has good vision, hearing, and speaking to promote information exchange.
• Must be able to stand and use copier, collate, staple, and bind large packets for meetings.
• Occasionally may have to lift boxes of office supplies and stack reams of paper on high shelves.
• Must be able to frequently problem solve, make decisions, interpret data, organize and analyze work flow, write, plan, and use simple arithmetic.
• Work is conducted indoors.
• Requires sitting at a desk in an office setting.
• Requires entering patient rooms and conducting accurate charting
• Requires travel among physician offices in the DFW area
Major Activities of the job include:
• Must be able to operate general office equipment including but not limited to: computer, phones, and related media and information devices.
• Must have the ability to communicate in writing, speaking, and hearing, both in person and/or by telephone.
• Ability to appropriately discuss sensitive patient information with patient, family and staff
• Effective communication through telephone encounters to staff and patients
This job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designated to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Management retains the right to add or change the duties of the positions at any time with or without notice.