About NYC Health + Hospitals

Since 1875, South Brooklyn Health has established its reputation for clinical excellence and culturally competent care. It has designations as a Certified Percutaneous Coronary Intervention (PCI) Center, an Advanced Primary Stroke Center, an accredited Baby-Friendly Hospital, a U.S. News & World Reporthigh performing hospital. The hospital's staff is as diverse as the patients they serve. Interpreter services can be provided at any time of the day or night in over 130 languages.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

Shift: Tour 2: 8 A.M - 4 P.M

Purpose:

The purpose of this position is to improve the overall quality, completeness, accuracy, specificity and timeliness of physician clinical record documentation. To optimize DRG reimbursement and facilitate data quality in the hospitals Inpatient Services.

Specific Duties and Responsibilities:

1) Complete concurrent and retrospective reviews of patient records to evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, post admission complications and procedures for accurate Diagnosis-Related Group (DRG) assignment and Case Mix Index (CMI), risk of mortality, and severity of illness. Education/Training/Follow-up

2) Queries physician for incomplete, inconsistent, unclear or conflicting documentation to clarify and resolve conflicting information in the medical record prior to discharge and or billing.

a) Maintains a record of review and query activities and other appropriate records.

b) Reconcile DRG mismatch with coding staff prior to submission of cases for billing.

c) Communicate with coding staff on clarification of clinical criteria needed to support documentation in the record.

3) Assist in the denial process when applicable by writing appeals on denied diagnoses and/or procedures.

4) Attends and/or participates in staff departmental and interdisciplinary meetings, process improvement events, training and quality assurance/performance improvement activities.

5) Performs other related work, as assigned by supervisor.

Minimum Qualifications

1.Valid New York State license and current registration to practice as a Registered Professional Nurse(RN) issued by the New York State Education Department (NYSED); and Bachelor of Science inNursing degree from an accredited college or university; and four (4) years of acute care experience;or

2.Valid New York State license and current registration to practice as a Nurse Practitioner (NP) issued by the NYSED; and two (2) years of experience, as described in “1” above; or

3.Valid New York State license and current registration to practice as a Physician Assistant (PA)issued by the NYSED; and two (2) years of experience, as described in “1” above; or

4.Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or

5.Successful completion of education that leads to a medical degree; and two (2) years of experience,as described in “4” above.

Please be advised that proof of Covid-19 vaccination is required prior to hire.

Job Type: Full-time

Pay: $103,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Paid time off
• Vision insurance

Physical setting:

• Hospital

Schedule:

• Day shift

Ability to commute/relocate:

• Brooklyn, NY 11235: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Utilization review: 1 year (Preferred)

License/Certification:

• RN License (Preferred)
• Nurse Practitioner License (Preferred)
• Physician Assistant License (Preferred)

Work Location: In person

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