Job description
St. John's Riverside Hospital is a leader in providing the highest quality, compassionate health care utilizing the latest, state-of-the-art medical technology. Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St. John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations.
St. John’s has been an integral part of the community since the 1890's and its’ commitment to provide the community with the most advanced medical services available continues to be the hospitals’ vision, mission and value. St. John's Riverside Hospital built itself around an early foundation of nursing and community service. In 1894, the Cochran School of Nursing, the oldest hospital-based school of nursing in the metropolitan area, was founded, thus making the St. John's Nursing Staff more than just the backbone of the hospital, but the heart and soul. St. John’s dedicated nurses give superior attention to those who need it most with a strong emphasis on patient and family-focused nursing care.
St. John’s Riverside Hospital staff is committed to making life better for all patients. The hospital continues to elevate the services provided with the goal of increasing the quality of life for all who entrust St. John's Riverside Hospital to their care.
Personalized care together with advanced technology is what it means to be Community Strong
Reviews inpatient medical records for identified payer population (Medicare, Medicaid, and Blue Cross/Blue Shield) as directed on admission and throughout hospitalization. Analyzes clinical status of patient, current treatment plan and past medical history and identifies potential gaps in physician documentation. Able to create and work with Excel Spreadsheets for monthly key metrics on denials. Consults and collaborates with the finance department to coordinate and maximize the efficiency and coordination of appeals.
Promotes customer satisfaction and works with Commercial Insurance companies as well as CMS to ensure that we are sending out information timely.
Demonstrates awareness of nursing skills, Milliman Clinical Review criteria, NYS LOCADTR, and CMS guidelines and regulations regarding appeals for authorization, medical necessity, and continued stay denials
Communicates with attending physician either verbally or through written methodology to validate observations and suggest additional and/or more specific documentation.
Works closely with Case Management and Clinical Documentation teams to assure documentation of discharge diagnosis(es) and any co-existing co-morbidities are a complete reflection of the patient’s clinical status and care.
Demonstrates basic knowledge about HIS standards of coding and applies to ongoing evaluation of medical record documentation.
Consistently meets established productivity targets for record review. Demonstrates knowledge of nursing theory, practice, and leadership ability.
Plans, organizes, coordinates, and evaluates the quality of clinical documentation and works collaboratively with Medical and Hospital staff to assure compliance. Identifies strategies for sustained work process changes that facilitate complete, accurate clinical documentation. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps identify problems, offers solutions, and participates in their resolution.
Maintains the confidentiality of information acquired pertaining to patient, physicians, associates and visitors to hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
Behaves in accordance with the Mission, Vision and Values of the hospital. Assumes responsibility for performance of job duties in the safest possible manner, to assume personal safety and that of co-workers, and to report all preventable hazards and unsafe practices immediately to management. Promotes the standards of care and service excellence according to Hospital philosophy and goals and/or unit guidelines.
Qualifications:
Minimum of five (5) years experience in adult inpatient medical/surgical or critical care or case management.
Embraces and adapts to change.
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