Conducts concurrent reviews of medical records to ensure provider documentation is accurate, complete, and reflective of the patient’s true clinical picture. This includes performing detailed chart reviews, issuing compliant queries, and participating in the reconciliation process. The role also supports departmental financial health, productivity, and ongoing professional development, with an emphasis on evidence-based practice.
This position may be fully remote.
Demonstrates knowledge of and adherence to Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
Performs concurrent reviews of selected patient records to assess clarity, completeness, consistency, and accuracy of clinical documentation.
Uses the compliant query process to obtain documentation that accurately reflects severity of illness, risk of mortality, comorbid conditions, length of stay, principal diagnosis, and POA status.
Completes the reconciliation process to ensure coding accurately captures the patient’s clinical complexity and documented conditions.
Develops and maintains collaborative relationships with providers and interdisciplinary team members, including education and follow-up as needed.
Remains up to date on changes in coding guidelines, clinical indicators, treatment modalities, and query compliance standards.
Serves as a resource for colleagues, providers, and support departments such as coding, case management, quality, and nutrition.
Assigns a working DRG to assist the healthcare team with discharge planning and CDI processes.
Performs additional duties as assigned.
This is a non-management position reporting to a supervisor, manager, director, or executive.
Associate degree in Nursing, Health Information Management, or a related field.
Two (2) years of experience in adult medical, surgical, critical care, ER, PACU nursing, coding, or a related discipline.
MD, DO, PA, or NP credentials may substitute for the required education and experience.
RN, RHIA, RHIT, CCS, CIC, or another related professional license or certification.
Strong computer proficiency.
Excellent communication skills with the ability to effectively interact with providers.
Working knowledge of IPPS, ICD-10 coding, MS-DRG/APR-DRG, and HCPCS systems preferred.
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