Description

The Mission of the San Francisco Department of Public Health (SFDPH) is to protect and promote the health of all San Franciscans. The City’s only complete system of care and has locations throughout the City, including Zuckerberg San Francisco General Hospital and Trauma Center, Laguna Honda Hospital and Rehabilitation Center, and over 15 primary care health centers.

•         Reviews inpatient medical records for identified payor populations  
•         Ensures that clinical documentation reflects the level of service
•         Utilizes both clinical and coding knowledge
•         Performs initial inpatient charts reviews
•         Manages the concurrent medical record review
•         Regularly participates in scheduled case management and hospitalist meetings
•         Maintains up to date working DRG
•         Assists in the development of diagnosis/DRG specific queries
•         Effectively utilizes documentation improvement communication tools.   
•         Proficiency in utilization of computer-based tools in retrieving and maintaining inpatient census data, coding and              audit tracking.   
•         Utilizes the encoder software to determine the working DRG and communicates daily with the HIM coding staff.   
•         Resolves inconsistent, conflicting and/or ambiguous documentation through the physician query process.  
•         Follows up with the physicians to get resolution of all queries prior to patient's discharge.   
•         Takes responsibility and assists coders
•         Maintains good rapport and cooperative relationships
•         Performs audits on the encoder software to facilitate ongoing auditing, monitoring and corrective action within the            Clinical Documentation Improvement (CDI) process   
•         Works with health information management coding staff, physicians and financial services with regards to payment            denials, medical necessity and documentation issues. Instructs staff on proper documentation in the                                    medical record.  
•         Reviews audit inpatient claims with medical necessity denials
•         Maintains detailed Case Mix Index (CMI) reports
•         Maintains DRG assignment mismatch report of differences
•         Fosters respect for privacy by maintaining confidentiality
•         Has knowledge of and performs the duties in accordance with the ethical and legal compliance standards
•         On an ongoing basis, educates all members of the patient care team
•         Actively participates and assists Performance Improvement Department
•         Performs other job-related duties  

Requirements

Required Qualification:   

License: Possession of a valid permanent/temporary (including interim permit) California Registered Nurse  

Experience: At least one (1) year of experience working as a Registered Nurse.

CDI Specific experience: 

•       Certified Clinical Documentation Specialist (CCDS)  
•       minimum of 3 years of clinical experience in an acute care setting  
•       minimum of 2 years clinical documentation integrity/improvement experience in any setting.