J ob Summary
The Clinical Documentation and Utilization Review Coordinator (CDURC)is responsible to
facilitate timely utilization review, documentation review, and an organized
submission/tracking of Medicare ADR and Cert responses to maximize reimbursement,
minimize payment denials and promote clinically appropriate continuity of care for patients
across the MedStar NRH Rehabilitation Network. In this role, the CDURC provides feedback
on patterns identified to promote process improvement, tracks documents and
communicates results of our efforts with payers, working in collaboration with Network,
Clinical and Revenue Cycle Management leadership to identify, and then implement,
ongoing process improvement opportunities to maximize our success as a Network.
Position also involved in assessing patterns in clinical service reimbursement to find denial
patterns with identified payers, working with Network leadership to determine acceptable
corrective actions to mitigate write offs and maximize reimbursement for services provided.
Licensed Physical Therapist or
Minimum requirement is a Bachelors
Degree from an accredited physical or
occupational therapy program.
Minimum of 4 years clinical experience in
an ambulatory rehabilitation environment .
Primary Duties and Responsibilities:
Coordinate and conduct clinical medical
record reviews to ensure complete and
timely submittals for pre-and post payment
documentation requests (e.g. Medicare
ADR and CERT requests, etc).
Review patient records, checking for
accuracy and completeness in accordance
with established medical record, clinical
documentation, admission/discharge, &
peer review policies and criteria. Provide
feedback on patterns identified to clinical
leadership for process improvement
Maintain data and abstract data/statistics
from record reviews in monthly, quarterly,
and year end reports.
Communicate and coordinate
documentation and utilization review in
collaboration with Outpatient Director
Informatics, Regional/Clinical Directors,
and Revenue Cycle Management
Identifies strategies for sustained work
process changes that facilitate complete,
accurate and timely clinical
Assists with the training of the therapy
staff, care management staff and other
clinical personnel on documentation to
ensure that the record accurately reflects
the most accurate picture of the patient’s
Demonstrates basic knowledge about
Health Information Management standards
of coding and applies them to ongoing
evaluation of medical record
Analyzes the clinical status of the patient,
current treatment plan and past medical
history, and identifies potential
improvements in documentation.
Works with revenue cycle team members
and analyses payment history to
determine payer reimbursement patterns
for service provided. As patterns are
identifies, works with Network Leadership
to determine appropriate corrective actions
to maximize reimbursement for services
MedStar National Rehabilitation Network - 22 months ago
MedStar National Rehabilitation Network provides the very best in rehabilitative services, including:
Award-winning inpatient care, with...