Clinical Document Specialist 3

The role of this position is to serve as an auditor in the Revenue & Insurance Audit Unit within the Patient Financial Services Department. The auditor does retrospective reviews and analyses of patient medical records in comparison to the patient final bill. The data collected is used to ensure clean bills as per contract requirements, re-bill for charge corrections and to negotiate settlement with third party payers.

Apply By Date

1/3/2025 at 11:59pm *REPOSTED

Minimum Qualifications

For full consideration applicants are encouraged to upload license and certification if required of the position.

* Bachelor's degree in nursing or related area, and / or equivalent combination of experience / training required.

* Experience reading/abstracting electronic medical record documents and interpreting the clinical information.

* Experience with the clinical and operational issues involved with inpatient care, including the diagnoses, treatments, medical procedures, complications, co-morbidities, discharge, and other practices that are part of effective clinical care systems.

* College level understanding of disease processes, anatomy and physiology necessary to interpret critical lab values, medical necessity of diagnostic and therapeutic procedures, and the administration of medications.

* Knowledge of and understanding of multi-medical specialties, and procedures in acute and critical setting.

* Ability to read/abstract electronic medical record documents and interpret the clinical information.

* Comprehensive knowledge of medical diagnostic and procedural terminology required.

* Proficient in Microsoft Word and Excel.

* Ability to perform mathematical computations and statistical analysis to support billed charges, including billed pharmacy charges.

* Computer skills to input and extract information from billing system.

* Ability to read and comprehend English text and medical terminology: knowledge of medical and nursing treatment plans, levels of care associated with acute and critical care.

* Skills to perform in-depth chart analysis to provide accurate information in a concise, informative manner, identify/analyze problems or issues related to areas of responsibility.

* Ability to communicate and work with varied health care team professionals in a manner that establishes a good rapport and professional working relationship.

* Ability to work efficiently and independently, maintaining a calm manner while under pressure.

* Ability to organize work to accommodate special projects, deadlines and priorities; ability to be both flexible and adaptable in order to coordinate multiple variables and to respond to the need of a multi-faceted work area.

* Understands the need to utilize discretion and maintain confidentiality when discussing patient matters.

* Successfully applies interpersonal communication skills in areas such as conflict management.

* Ability to be flexible and adaptable in order to accommodate the needs of a multifaceted work area.

* Demonstrates leadership skills sufficient to direct others toward accomplishing goals in a positive manner that are conducive to overall positive operations within the department.

* Verbal and written communication skills to clearly and concisely receive, elicit and convey information regarding documentation issues with the medical staff and other health care providers.

* Written communication skills to clearly and concisely compose letters, reports, policies and procedures that may include medical, financial and administrative information. *Ability to exercise judgment with minimal supervision.

* Ability to be flexible, adaptable and follow many different guidelines which change frequently.

* Ability to handle the stress and pressures of a job where there is noise from conversation and other interruptions.

* Ability to read text for a long period of time from a book, medical record and/or computer terminal.

* Must be able to work occasional overtime.

Preferred Qualifications

* Current California RN license preferred

* 3+ years experience in a similar Nurse Auditor role

* 1+ year experience working in EPIC Resolute - HB

Key Responsibilities

* 75% - Internal Audits

* 10% - Transfer Requests, Medicare ADR's, Follow-up, Legal

* 5% - Observation Case Review

* 5% - Organ Donor Pre-Bill Review

* 5% - External (Defense) Audits

Department Overview

Patient Financial Services (PFS) manages revenue cycle functions including DNFB, billing, contract management, insurance follow-up, charge audit, denials, underpayments as well as internal operational and functional reporting and support related to hospital/facility billing. PFS ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services rendered. PFS impacts processes to include charge capture, coding, insurance identification, data/charge entry, registration, authorizations, billing, payment posting, refund processing and collections.

POSITION INFORMATION

* Salary or Pay Range: $3,524.90 - $6,590.03

* Salary Frequency: Biweekly

* Salary Grade: Grade 24

* UC Job Title: CLIN DOC SPEC 3

* Number of Positions: 1

* Appointment Type: Staff: Career

* Percentage of Time: 100

* Shift Hours: 8am to 4:30pm, 8 hour

* Location: UCDHAS Building (HSP165)

* Union Representation: 99 - Non-Represented (PPSM)

* Benefits Eligible: Yes

* Hybrid/Remote/Onsite: This position is hybrid (mix of on-site and remote work)

* THIS IS NOT AN H1- B OPPORTUNITY

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.universityofcalifornia.edu/labor/bargaining-units/index.html

* High quality and low-cost medical plans to choose from to fit your family's needs
* UC pays for Dental and Vision insurance premiums for you and your family
* Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave
* Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Access to free professional development courses and learning opportunities for personal and professional growth
* WorkLife and Wellness programs and resources
* On-site Employee Assistance Program including access to free mental health services
* Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage
* Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles
* Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans. More information on our retirement benefits can be found here
* UC Davis cares about building a community, which is why we provide resources to enhance diversity, equity and inclusion as well as Employee Resource Groups (ERGs) to support our staff

Physical Demands

* Sitting - Continuous 6 to 8+ Hours

* Keyboard use/repetitive motion - Continuous 6 to 8+ Hours

Environmental Demands

* Loud noise levels - Occasional Up to 3 Hours

Mental Demands

* Sustained attention and concentration - Continuous 6 to 8+ Hours

* Complex problem solving/reasoning - Continuous 6 to 8+ Hours

* Ability to organize & prioritize - Continuous 6 to 8+ Hours

* Communication skills - Continuous 6 to 8+ Hours

* Numerical skills - Continuous 6 to 8+ Hours

* Constant Interaction - Occasional Up to 3 Hours

* Customer/Patient Contact - Occasional Up to 3 Hours

* Multiple Concurrent Tasks - Continuous 6 to 8+ Hours

Work Environment

Must be able to work occasional overtime and flexible hours as needed for projects. These positions are subject to a criminal background investigation. See Skills, Knowledge and Abilities for additional information.

Special Requirements

• This is a critical position, as defined by UC policy and local procedures, and as such, employment is contingent upon successful completion of background check(s), including but not limited to criminal record history background check(s)
• This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements
• Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Diversity, Equity, Inclusion and Belonging

At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds and you belong here. As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected. The University of California, Davis is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/PPSM-20

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere