Registered Nurse (RN) Clinical Documentation Denials Auditor

Inova Health is looking for a dedicated Registered Nurse (RN) Clinical Documentation Denials Auditor to join the team. This role will be fully-time remote, Monday-Friday, regular business hours 8:00 AM – 4:30 PM (EST). Inova’s hospitals are consistently recognized by the Centers for Medicare and Medicaid Services (CMS), U.S. News & World Report Best Hospitals and Leapfrog Hospital Safety Grades for excellence in healthcare. We are proud to be named one of Forbes’ 2022 Best Employers for Women, #11 of 5,000+ facilities on NurseJournal’s national 2023 Best Places to Work as a Nurse list, and a Top Performer in the 2022 Healthcare Equality Index for LGBTQ+ Healthcare Equality. Featured benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities

Registered Nurse (RN) Clinical Documentation Denials Auditor Job Responsibilities:

• Evaluates specificity and completeness of physician documentation to ensure optimal coding (e.g. mortality outcomes using APR-DRG, SOI and ROM, appropriate reduction of complications based on PSI and HAC, revenue assurance outcomes based on reimbursement DRG (MS-DRG), documentation of significant chronic conditions affecting resource utilization based on HCC).
• Summarizes audit findings for individual records along with specific documentation guidelines to improve expected clinical outcomes for an individual physician, physician practice, or specialty.
• Conducts follow-up audits (i.e. concurrent or post-discharge) with routine feedback until documentation practice comes into line with expected clinical outcomes.
• Works with Clinical Documentation Improvement (CDI) Director and Lead Auditor on other work related to physician audits and education programs.
• Demonstrates proficiency with Cobius to access external audit work, record summary results and upload appeal letters.
• Demonstrates proficiency with Encompass 360 and HDM audit functions to review electronic medical records with advanced functions (i.e. ex, auto-suggest and search) and record detail coding audit results.
• Showcases proficiency in reviewing records in Epic electronic medical records – which may be the only option for audits of older records.
• Demonstrates proficiency in writing effective appeal letters that include appropriate coding guidelines and medical references.
• Identifies trends in external audit findings related to coding quality and physician documentation. Prepares educational communications related to these findings.
• Evaluates physicians' documentation, diagnostic reports, and clinical findings for validation of diagnoses.
• Processes the requests for second opinion reviews when clinical validity is not supported or in question.
• May perform additional duties as assigned.

Minimum Qualifications:

• Certification: Certified Coding Specialist / Certified Clinical Documentation Specialist; ACDIS/AHIMA certification, CCDS or CDIP
• Licensure: Current RN license and eligible to practice in VA
• Experience: Seven years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD; Coding certification CCS and CDI certification CCDS or CDIP
• Education: Associate Degree in Nursing or Medicine.

Preferred Qualifications:

• Experience: Must have: CDI, DRG, and Coding audit experience. Recent coding experience. Clinical background and coding + denials knowledge. Experience writing denials & appeals. Outpatient and/or inpatient experience. Knowledge to identify clinical indicators (example: sepsis). EPIC experience.
• Certifications: CCDS
• Skills: presenting

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states – VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

About Us

We are Inova Health, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 24,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare. Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law. Job Type: Full-time Pay: $40.79 - $66.49 per hour Expected hours: 40 per week Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

License/Certification:

• CCDS (Preferred)

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