APC or MD Clinician Reviewer

UnitedHealth Group • Eden Prairie, MN

129d • $89,900 - $140,000 • Onsite

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Clinical Practice Performance physician (MD, DO), nurse practitioner (NP) or physician assistant (PA) will apply clinical expertise and knowledge of documentation guidelines to ensure quality of clinical documentation across Optum Health. This position will collaborate with a multidisciplinary team of clinicians, operations, and coding professionals as a member of the Clinical Documentation Review team within Optum Clinical Excellence. This position will provide support to Optum clinicians and leadership to promote excellence in clinical documentation. This position is Monday - Friday and reports to the Associate Director, Clinical Documentation Review, in Optum Clinical Excellence.

Requirements

• Board certification in respective clinical field, for example: Nurse Practitioner national certification in Adult, Adult-Geriatric, Family or Acute
• Certification by the National Commission on Certification of Physician Assistants (NCCPA)
• Active unrestricted state license to practice in respective clinical field
• 5+ years of clinical practice experience
• Demonstrated solid clinical background in evidence-based medicine including chronic disease management and prevention
• Experience in ICD-10 coding and documentation requirements
• Ability to perform a comprehensive chart review of multiple medical records per day
• Technical experience using different EMR systems (e.g., EPIC, eClinical Works, Touchworks)
• Proficiency in MS applications (Excel, Outlook, Teams, PowerPoint & Word)
• Ability to be flexible and able to adapt to change based on departmental needs
• Proven excellent analytical and critical thinking skills
• Proven excellent verbal/written communication and people skills
• Ability to work independently and as part of a team in a fast-paced environment
• Ability to travel for on-site meetings 1-2 times per year

Nice To Haves

• Coding certification from AAPC or AHIMA professional coding association or additional coursework/experience in coding and/or Risk Adjustment
• Experience working with Medicare Advantage programs and CMS Risk Adjustment model
• Work experience in clinical documentation review or in a clinical quality program
• Experience developing and delivering clinical education and training
• Bilingual (English/Spanish)

Responsibilities

• Performs clinical chart reviews to ensure documentation accuracy by applying established clinical criteria for the diagnosing of medical conditions
• Reviews reported diagnoses for clinical validation within the visit note or medical record
• Identifies documentation errors and opportunities for documentation improvement and documents review findings in a standardized form/audit tool
• Collaborates with team members as part of the clinical review process to promote accuracy and consistency of results
• Meets accuracy and productivity metrics to ensure team achieves established departmental goals
• Communicates with Optum leaders to address documentation issues and trends
• Provides recommendations for education to Optum Health businesses and clinicians to improve documentation
• Actively participates in all department meetings as scheduled
• Performs related duties, as required

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed