The Clinical Documentation Specialist (CDS) is responsible for planning, coordinating and providing education to faculty, APPs, and house officers related to clinical documentation improvement and clinical revenue optimization for the Department of Internal Medicine and the UMMG. Apply their knowledge of medical terminology and coding to create and implement education plans and communicate the principles and importance of accurate and complete documentation to ensure appropriate payment for clinical services—both professional and facility. Partner with the department’s Physician Champion to identify gaps and opportunities for revenue capture and assist with implementation of processes in the inpatient and ambulatory clinical settings. Understand and articulate data and analysis specific to faculty/APP/house officer clinical documentation, charge capture, and revenue activity. Provide updates to leaders on status and progress of efforts to improve revenue capture. Maintain strong collaborative relationship with the Revenue Cycle department via the Revenue Quality Liaison (RQL).
Serves as the primary source of contact and resource for faculty, APPs, and house officers with regard to clinical documentation and medical coding for patient care services
Develops tools to assist providers with efficient, effective documentation and accurate coding
Prepares reports to provide feedback on provider and coding performance including state of documentation, charge capture, and reconciliation
Identifies documentation trends to be shared with the Physician Champion to allow for clinician education
Provides group and one-on-one education for faculty, APPs, and house officers, as needed
Prepares case and specialty specific documentation examples and power point presentations to be shared at department meetings
Analyzes data to prioritize areas of RVU recovery
Assists with UMMG and department initiatives to improve revenue and reduce avoidable write offs
Develops strategies to optimize inpatient and outpatient charge capture and facilitate change processes required
Serves as a resource on documentation requirements and ensure compliance with applicable laws and regulations
Assists in onboarding new faculty and house officers with orientation to documentation, coding and reports
Performs chart reviews for the purpose of providing feedback to individual providers
Partners with the RQL to ensure smooth handoffs and follow-up to units within Revenue Cycle and ensure consistent communication between all parties
Maintains current with specialty coding updates, work processes, tools, and clinical and administrative applications necessary to perform job functions
Project a professional and positive image when interacting with patients, faculty and staff
Performs other duties appropriate to the CDS function, as assigned
Associate’s Degree or equivalent
At least five years of medical coding experience
Current RHIT, RHIA or CPC certification
Demonstrated experience providing clinical documentation and coding education to providers
Excellent communication skills (verbal and written) to enable effective outcomes with the diverse complex clinical care teams.
Ability to navigate the EHR to identify documents for review to provide accurate capture of clinical information.
Extensive CPT and ICD-10 coding knowledge
Medical terminology and clinical knowledge with the ability to review documentation and determine what documentation is needed to provide accurate medical codes
Ability to work independently, self-motivated and an ability to adapt to the changing healthcare environment
Proficiency in organizational skills and planning with an ability to juggle multiple priorities in a fast changing environment.
Proficiency in computer use including Microsoft Office Suite experience
Provide support to clinicians on navigating the EHR to make addendums, create SmartTexts and SmartPhrases and utilize templates
Attention to detail with thoroughness and accuracy when accomplishing a task
Possess proactive, strategic, innovating and out-of-the-box thinking
Flexibility to work on-site and remotely
Bachelor's degree level education
Knowledge and/or experience with coding and clinical documentation for Internal Medicine Specialties
Availability to work a flexible schedule as meetings with faculty or residents may need to occur in the early morning or early evening
Self-starter with ability to work independently as well as within the framework of a team
The CDS will be supervised by the Chief Department Administrator or designee.
The CDS does not have supervisory responsibilities.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 193086
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.