Nurse Chart Reviewer

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 Nurse Chart Reviewer will be responsible for educating others on appropriate documentation and coding, based on chart review findings. The Nurse 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.

Education, Experience, Skills

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 and Interpersonal Skills

  • 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, teach
    • Ability to hold providers accountable & educate same on new methods and practices
    • Ability to listen
    • Able to resolve conflict
    • Ability to accept input from others
    • Ability to give clear direction and provide feedback
    • Ability to accept coaching from others
  • Able 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
  • Current and active Driver’s License
  • Access to a reliable vehicle and Automobile Liability Insurance
Apply Now