Nurse Chart Reviewer

** No nights, weekends, or holidays ! **

Tandigm Health, LLC is a value-based population health organization. We engage our physician network by aligning economics and rewarding them for the value of the care they provide rather than for the volume of services. We enable our physicians with innovative tools, actionable data, expert training and education, and clinical delivery support. We empower our physicians by building community-oriented care delivery systems that facilitate collaboration across the continuum of care.

At Tandigm you will find a culture where all Teammates have the opportunity to collaborate in an energized, multi-disciplinary work environment focused on improving patient outcomes and enabling our staff to do some of the most rewarding work of their careers.

The Nurse Chart Reviewer is responsible for performing thorough chart reviews in order to inform providers of potential inferred, embedded, and missing diagnoses not previously identified and to aid in the education and discovery of opportunities for improved coding and documentation. The RN Chart Reviewer will be responsible for educating others on appropriate documentation and coding, based on chart review findings. The RN Chart Reviewer is licensed in the state of Pennsylvania, with knowledge of coding and documentation requirements and guidelines & is able to travel within the five county Philadelphia, PA territory (Philadelphia, Montgomery, Chester, Bucks, Delaware counties) as needed.

Essential Functions

  • Consistently exhibits behavior and communication skills that demonstrate Tandigm’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer;
  • Obtains access and reviews all Medicare Advantage charts assigned, both remotely and onsite at Physician practices;
  • Reviews all portions of the medical records including but not limited to problem lists, past medical and surgical history, medication lists, specialty and primary care notes, imaging, hospital records, labs and vital signs;
  • Documents newly found diagnoses and/or screenings and reports out to practices as needed;
  • Brings clinical questions to the ACE Medical Director as needed;
  • Provides in-person debriefings to the practices and internally using all required reports including newly suggested chart review diagnoses. Records debriefing comments/ feedback for ACE team;
  • Recommends ongoing chart review process to ensure continued high standards in documentation and coding;
  • Attends and participates as requested in regional and corporate meetings that pertain to ACE coding and documentation;
  • Attends courses as needed to improve knowledge of accurate coding and documentation;
  • Uses, protects, and discloses Tandigm’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards; and
  • Performs additional duties as assigned.

POSITION REQUIREMENTS: Education, experience and skills

Education and Experience

Minimum:

Bachelor’s Degree in Nursing required (8 or more years of additional experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree);

  • Current, active, and unrestricted Pennsylvania Registered Nurse Licensure;
  • 5 years of General Clinical experience required;
  • Two years of clinical chart or claims review experience with strong attention to detail;
  • Knowledge of CMS /RAF model, coding and guidelines along with ICD-10 guidelines;
  • Knowledge of health plan and regulatory requirements;
  • Strong technical skills including computer and software skills such as Microsoft Word, Excel, and Outlook;
  • Experience with at least one EMR and chart abstraction tools

Preferred:

  • Additional Quality Assurance auditing experience;
  • Additional Chart Review Experience

Essential Technical/Motor/Interpersonal Skills/Other

  • Embraces and exemplifies core values of Tandigm Health;
  • Ability to anticipate and analyze factors;
  • Strong oral and written communication skills;
  • Possesses leadership qualities, such as: Ability to mentor, counsel, coach, and teach;
  • Ability to hold providers accountable & educate same on new methods and practices;
  • Ability to listen, resolve conflict and ability to accept input from others;
  • Ability to give clear direction and provide feedback, as well as ability to accept coaching from others;
  • Ability to develop effective strategies for implementation of improved coding and documentation practices;
  • Values team members and a strong team player;
  • Possesses high ethical standards;
  • Ability to work independently;
  • Must possess current and active Driver’s License & ability to drive throughout the five county Philadelphia, PA region as necessary;
  • Access to a reliable vehicle and Automobile Liability Insurance

Physical Requirements in Accordance with ADA

  • Carrying/Lifting: Occasional, 0-25 lbs;
  • Standing: Frequent, up to 6 hours per day;
  • Sitting: Frequent, up to 6 hours per day;
  • Walking: Frequent, up to 6 hours per day;
  • Repetitive Motion: Keyboard activity, telephone use, writing, reaching, grasping, pushing, & pulling;
  • Visual Acuity: Ability to view computer monitors and read newsprint, with or without corrective lenses;
  • Environmental Exposure: None

If you believe you have what it takes, we’d love to hear from you. Come see why Modern Healthcare named us as one of their Best Places to Work” again ! Apply today !

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