UNIVERSITY OF WASHINGTON

Specification for Class

CLINICAL DATA SPECIALIST - UTIL MGMT

UW CODE AND REPRESENTATIVE GROUP

8365 (SEIU Local 925 Clerical Nonsupervisory)

BASIC FUNCTION

Justify admission and continued stay of designated patients as required for agency reimbursement; abstract patient data; obtain initial admitting diagnosis and working Diagnostic Related Group (DRG).

DISTINGUISHING CHARACTERISTICS

Under general direction, using appropriate criteria, review chart documentation to justify patient care in order to meet agency reimbursement requirements and to justify admission, treatment and length of stay. Concurrently monitor patients to assure the appropriateness of admission, continued hospitalization, length of stay, utilization of resources, and any potential denial of payment issues. Evaluate documentation regarding severity of illness and intensity of service for variation from regulatory agency standards; consult with physician advisor as necessary to resolve deviations; document patient needs for continued hospitalization.

TYPICAL WORK

Review all designated admissions for appropriateness; follow-up at pre-determined intervals for continued stay using designated criteria;

Communicate with outside agencies to justify approved inpatient stays;

Obtain and report coding and DRG as requested to facilitate transfers or aid in insurance approval and interim billing;

Monitor patient length of stay, evaluate for variation from regulatory agency standards and consult with physician advisor as necessary;

Act as information resource to physicians, other departments, health care facilities and agencies, assess health record to assure documentation supports services provided;

Notify appropriate persons of denials and/or potential denials for non-covered services and other problems; initiate correspondence to appropriate agencies and to attending physician for appeal of denials;

Abstract variances, enter in data bases, and chart utilization review information into the patient health record;

Issue decertification letters according to physician advisor;

Identify potentially avoidable days for reimbursement and identify systemic issues that contribute to delays in service or inefficient uses of resources;

Complete patient abstracts according to outside agency guidelines;

Participate in multidisciplinary team meetings to facilitate communication on issues related to utilization and coverage for care and services; help with care planning; contribute to performance improvement initiatives; collect and report specific indicators;

Refer patients with potential continuing care needs to appropriate departments such as social services, pharmacy and financial services;

May train new staff;

May direct or coordinate the work of others;

Perform related duties as required.

MINIMUM QUALIFICATIONS - UW Contract Classified
DESIRABLE QUALIFICATIONS - Classified Non-Union

Certified as a Registered Health Information Technician (RHIT) AND two years of healthcare related experience

OR

equivalent education/experience.

New Class: 9-1-02

CSR Class Conversion (mc): 06-01-05