[Hiring] Clinical Documentation Specialist RN @Johns Hopkins Medical Management Corporation

Role Description

The Clinical Documentation Specialist (CDS) is responsible for:

• Distributing documentation information to respective departments.
• Performing educational outreach to individual units and provider groups.
• Supporting training of new staff members.
• Designing and developing educational tools for staff and Providers.
• Facilitating improvement in the overall quality and completeness of concurrent medical record documentation.
• Helping achieve accurate inpatient coding, APR-DRG assignment, severity level, and reimbursement.
• Functioning as subject matter liaison and leading documentation improvement initiatives.
• Serving on internal hospital committees.
• Obtaining appropriate documentation through interactions with physicians and collaboration with other departments.
• Additional responsibilities as assigned.

Shift/hours: Mon – Fri, 8:00am-5:00pm EST Location: 100% Remote (EST hours)

Payrate: $60 hourly

Qualifications

• Baccalaureate degree, or associates degree, or diploma in nursing from an accredited school of Nursing OR successful completion of an AMA approved Physician Assistant program OR successful completion of the academic requirements of Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) certification accredited by CAHIIM.
• Active RN License.
• EPIC experience.
• 12 months current RN experience in a similar role in MD or nationally using MSDRG.
• Medicare Coding regulations 2024.
• Minimum of 3 years Registered Nurse clinical experience in a similarly complex acute care setting.
• Minimum of 2 years as a Clinical Documentation Specialist required.
• In lieu of complex acute care experience, a minimum of 3 years of CDI experience and/or other relevant clinical experience may be considered.

Requirements

• Comprehensive knowledge of anatomy, physiology, and all body systems.
• Strong background knowledge of disease processes and pharmacology.
• College-level knowledge of Medical Terminology.
• Complete understanding of the unique functions of each clinical area.
• In-depth knowledge of clinical coding processing and documentation standards, guidelines, policies, and procedures.
• Conversant in clinical documentation improvement.
• High level of proficiency in adult education and training.
• Thorough understanding of Hospital bylaws and Joint Commission standards.
• Proficiency in abstraction and data entry into all database systems used for clinical documentation.
• Ability to read and interpret electronic and manual documentation generated by healthcare professionals.
• Understanding of HSCRC, Maryland Quality Improvement Programs, and CMI impact on hospital budget.
• Knowledge of Healthcare Insurance Portability and Accountability Act (HIPAA).

Skills

• Conversant in ICD-10-CM, APRDRGs, DRGs.
• Strong interpersonal and communication skills (verbal, non-verbal, and listening).
• Understanding of adult learning theory, instructional design, and critical thinking.
• Competent level with Microsoft Office Suite, web-browsers, email, electronic health records, online collaboration software, and virtual meeting applications.
• Ability to work in a dynamic, team-oriented environment.
• Ability to work independently and be self-directed.
• Ability to work under pressure to meet submission, project, and reporting deadlines.
• Ability to work in a fast-paced academic teaching hospital.

Company Description

Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Our employees are the strength of our service. Intrastaff is unique because it's one of the very few agencies where a person has the benefit of being a temporary employee and also feels like a member of a large organization. Working at Hopkins means joining a culturally diverse team that includes some of the best nurses, physicians, and allied health professionals in the world. Directly or indirectly, you'll have exposure to cutting-edge technology and groundbreaking medical research.