Clinical Documentation Associate

NeoWork is currently seeking a meticulous and organized Clinical Documentation Associate to join our team. As a Clinical Documentation Associate, you will be responsible for ensuring accurate and comprehensive clinical documentation for healthcare providers.

NeoWork is dedicated to providing efficient and high-quality healthcare services. The Clinical Documentation Associate will work closely with healthcare professionals to review medical records and ensure that they accurately reflect the patient's condition, treatment, and outcomes. This role is crucial in supporting effective communication, billing, and reimbursement processes.

We are looking for someone who has excellent attention to detail, strong communication skills, and a solid understanding of medical terminology and clinical documentation guidelines. The ideal candidate should have previous experience in clinical documentation or related roles.

Responsibilities

• To review progress visits and submit for therapist signature and approval if the chart meets Charting Best Practices.
• To reject charts that do not meet best practices and forward to the US charting team for further review
• To audit US charting team charts for accuracy by transcribing therapist procedure minutes to the billing section of the chart. 
• Review medical records to ensure accurate and complete clinical documentation
• Collaborate with healthcare professionals to clarify medical documentation and resolve documentation queries
• Ensure compliance with clinical documentation guidelines and standards
• Identify gaps in documentation and communicate findings to the appropriate healthcare professionals
• Provide education and training on clinical documentation improvement to healthcare providers
• Participate in audits and quality assurance activities related to clinical documentation
• Maintain accurate and up-to-date records of documentation activities
• Adhere to confidentiality and compliance requirements
• Assist with other administrative tasks as needed

Requirements

• Bachelor's degree in healthcare administration, nursing, or a related field
• At least 2 years of experience in clinical documentation or a similar role
• Experience in treating patients and familiarity with clinical notes.
• Experience in assessing therapist progress notes for signs that treatment is being advanced.
• Strong knowledge of medical terminology and clinical documentation guidelines
• Excellent attention to detail and ability to maintain accuracy in a fast-paced environment
• Strong communication and interpersonal skills
• Ability to collaborate effectively with healthcare professionals
• Knowledge of healthcare regulations and compliance requirements
• Analytical mindset and problem-solving skills
• Owned computer or laptop and stable internet connectivity.
• Knowledgeable in Office 360, Google Apps, and client-facing communication.

Benefits

• We provide comprehensive training for all candidates, regardless of their background or previous experience as a VA.
• The work hours generally align with standard business hours in the US, with some potential flexibility depending on the client's needs.
• This is a 100% home-based position
• We prioritize the mental health of our team members and offer mental health days to support their well-being.
• In addition to the base salary, performance-based incentives are provided.
• There is an annual review and appraisal process in place.
• There are ample opportunities for professional growth and advancement within the company.