NOTE: CANDIDATES MUST LIVE IN CALIFORNIA.

If RN, NP, PA  - Must have ACTIVE License
Candidates with MD or PA designations must have at least 3 years of patient contact
(Must have at least 3 - 5 years of inpatient patient care clinical experience.)

Prefer CCDS or CDIP certification, Epic experience,
Must have knowledge of HCCs (Hierarchical Condition Categories), EPIC and MS-DRGs.



Education/License/Certification: 
Graduate from an accredited school of nursing (BSN required).
Current licensure to practice as a Registered Nurse in California.
Or Medical Doctor license outside/inside the US.
OR Physician Assistant (PA) license. 

Qualifications: 
Nursing/Clinical: Minimum of 3-5 years clinical experience (i.e. inpatient, clinical documentation, discharge planning, or case management).
Knowledge of MS-DRGs and the payment methodology. 

Strong interpersonal, communication (verbal, non-verbal, and listening skills
Demonstrated ability to conduct and interpret quantitative/qualitative analysis.
Proven leadership skills in project management and consulting.
Must exhibit efficiency, collaboration, candor, openness, and results orientation.
Understand Adult Learning Theory.
Competent computer skills including word processing, spreadsheets, and presentation software. 

Preferred Qualifications: 
Must have a nursing background. MD or PA may qualify depending on background and experience.
Masters optional. 

Duties: 
Adheres to the hospital standards to promote a cooperative work environment by utilizing communication skills, interpersonal relationships and team building.
Establishes effective working relationships with the local and regional staff/teams/leadership.
Facilitates appropriate clinical documentation to support diagnosis capture and to ensure the level of service rendered to all patients is recorded.
Identifies and reviews primary and secondary diagnosis and complications to ensure diagnosis documentation and capture through addendums may identify patients who need to be seen.
Identify and review for POA (Present on Admission) documentation.
Reviews clinical issues with medical coding staff and with physicians to identify those diagnoses that impact severity of illness indicators for each patient. Serves as an expert resource in reviewing all medical records in support of consistent documentation for all payer types (i.e. CMS, Medicare-Advantage, etc) to ensure complete and accurate diagnosis capture and coding. 

Collaborates in the development of programs which provide alignment with education for internal customers to support clinical documentation guidelines. Communicates information effectively with medical center leaders.
Works with Coding Review Manager to develop, implement and monitor departmental policies and procedures that support organizational goals, business objectives, regulatory needs and requirements.
Conducts data and root cause analysis, provides feedback and shares findings on the analysis to leaders, local regional management and medical team. Queries medical staff for accurate clear documentation in the patients medical records.
Monitor and track verbal and written queries and produce reports as required. 

Consistently supports compliance and the Principles of Responsibility (Client’s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and Client's policies and procedures. 

In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Client's Service Quality Credo, the Client's Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.