Position Summary
Sovah Health is looking for the ideal candidate who will facilitate improvement in the overall quality, completeness, and accuracy of clinical documentation. Through concurrent interaction with physicians, case managers, coders and other health care team members, the Clinical Documentation Specialist, will strive to ensure comprehensive medical record documentation that reflects the clinical treatment, decisions, and diagnosis for all inpatients. Serving as a resource to all members of the health care team on documentation guidelines, this position will provide guidance and support, as well as assist with education and training related to improving clinical documentation.
Improves overall quality and completeness of clinical documentation by performing admission / continued stay reviews
Conducts timely follow-up reviews of clinical documentation to ensure that issues discussed and queries left in the medical record have been answered by the provider
Will utilize coding and clinical expertise to identify opportunities and ensure the accuracy and completeness of clinical documentation user for measuring and reporting physician and hospital outcomes.
Queries physicians on specificity of procedures performed and diagnosis based on accepted coding guidelines and clinical expertise.
Tracks and trends specific opportunities for improvement through the query process
Conducts educational sessions with physicians and other health care team members on documentation requirements.
Reviews clinical issues with physician advisors.
Participates in data collection for performance measures.
Stays current with requirements of CMS Inpatient Prospective Payment Systems (IPPS), AHA Coding Clinic and ICD-9-CM Official Guidelines for Coding and Reporting.
Participates in department and facility Quality and Performance initiatives.
Works closely with case management, quality management, risk management, and medical staff credentialing to provide data related to key clinical indicators and operational metrics.
Works in conjunction with the Directors of Quality Improvement, Medical Staff Credentialing and medical staff leadership to assure effective monitoring and successful completion of identified plans for improvement.
Prepares and presents educational programs using adult learning principles for identified improvement needs as indicated.
Makes regular reports of progress toward goals associated with clinical documentation improvement opportunities and operational improvement plans
Who We Are:
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Licensed for 220 beds, SOVAH Health Martinsville, is a full service, acute-care hospital providing over 22 medical specialties. Among the services we offer are a home health & hospice agency, advanced wound healing center, cardiac rehabilitation center, two cardiac catheterization labs, and medical & radiation oncology services.
Where We Are:
In Martinsville, explore culture and arts, enjoy kayaking or hiking and so much more in the foothills of the Blue Ridge Mountains. From the river to the racetrack, we offer plenty of activities to guarantee that you and your family have a fun filled time!
Why Choose Us:
Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
Competitive Paid Time Off / Extended Illness Bank package for full-time employees
Employee Assistance Program mental, physical, and financial wellness assistance
Tuition Reimbursement/Assistance for qualified applicants
Professional development, Growth opportunities, and Mentor-based training
And much more
Minimum Qualifications
Minimum Education
High school diploma or equivalent required, Degree in Nursing preferred. Additional Healthcare associated degree & education will be considered.
Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Licenses:
Licensed as a Registered Nurse in the Commonwealth of Virginia or compact state.
Certifications:
One of the following required if not an RN:
Certified Clinical Documentation Improvement Specialist (CCDS) or Certified Documentation Improvement CDI
Licensed Registered Nurse or LPN
Additional Healthcare Certifications considered
Certified Professional Coder-Hospital (CPC-H)
Certified Coding Associate (CCA)Registered Health Information Technician (RHIT)Registered Health Information Administrator (RHIA)Additional Coding Certificates will be taken under consideration (AAPC)
Minimum Work Experience2 years hospital experience
Prior experience in clinical documentation improvement and/or coding accuracy preferred.
EEOC Statement:
SOVAH Health - Martinsville is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.
Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran By applying, you consent to your information being transmitted by Jobcase to the Employer, as data controller, through the Employers data processor SonicJobs.
See Lifepoint Health Terms & Conditions at and Privacy Policy at and SonicJobs Privacy Policy at and Terms of Use at
`As the Data Analyst for the Security Analytics & Innovation team you will help in the development... ...problem-solving activities. This is an entry level role requiring the individual to have... ...two years of Administrative support experience OR Equivalent education/experience....
A bookkeeper's most important duty is to track and manage financial data. Bookkeepers don't interpret this data, which is the responsibility of accountants, so they focus less on analysis and more on creating and maintaining records. Documenting financial transaction...
...together. If you want to make an impact in fintech, wed like to know: Are you FIS? About the role: As a Production/Site Reliability Engineer youll help develop new fintech products that will change the way the world pays, banks and invests. This could involve working...
...Physician Led group seeks a Sleep Medicine Physician for the outpatient setting in Greensboro, NC! This group is Physician Led... ...neighboring community. ~ Group includes primary care, gastroenterology, endocrinology, sports medicine, sleep, ob-gyn, and pediatrics...
...Gray Tier Technologieshas an immediate need for a Microsoft Security Engineer for a new customer on a highly-visible and strategic... ...with 8-10 years of prior relevant experience. Expertise with Azure services and components to build, manage, and maintain Azure...