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UnitedHealth Group - Plymouth, MN

posted 23 days ago

Full-time - Mid Level
Remote - Plymouth, MN
Insurance Carriers and Related Activities

About the position

Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Clinical Documentation Integrity Specialist - (CDS) is responsible for providing CDI program support and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum clients' patients. The goal of the CDS practice is to assess the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service. This position reviews all clinical information and documentation to make improvements that result in accurate, comprehensive documentation that reflects completely the clinical treatment, decisions, and diagnoses for the patient. The CDS utilizes clinical expertise and clinical documentation integrity practices as well as facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum and their client partners. This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

Responsibilities

  • Perform concurrent and retrospective chart reviews for improving the overall completeness of clinical documentation
  • Keep abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI trends
  • Effectively utilizes ICD-10 and related materials to investigate coding issues and produce accurate results
  • Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
  • Provides expert level leadership for overall improvement in clinical documentation by providing proficient review and assessment, and effectively articulating recommendations for improvement including the rationale for the recommendations
  • Actively communicates with providers at all levels, to clarify information and to communicate documentation requirements for appropriate diagnoses based on severity of illness and risk of mortality
  • Provides complete follow through on all requests for clarification or recommendations for improvement
  • Ensures effective utilization of Technology to document all clarification activity
  • Collaborates closely with interfacing departments such as Care Coordination and Quality
  • Utilizes only the Optum/client approved clarification forms
  • Proactively develops a reciprocal relationship with the HIM Coding Professionals
  • Engages and consults with Physician Advisor/CMO when needed, per the hospital defined escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation integrity process

Requirements

  • Must be one of the following to qualify: Medical Graduate (MD or MBBS) with CDI experience or Registered Nurse (RN) with an active, unrestricted RN License in the US and 5+ years of acute care hospital experience
  • Experience communicating & working closely with Physicians
  • Proven proficiency in clinical medicine, pathophysiology, and pharmacology
  • Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records

Nice-to-haves

  • BSN degree if a RN
  • CCDS, CDIP or CCS certification
  • 3+ years of CDI experience for an acute care hospital
  • CAC experience (Computer Assistant Coding)

Benefits

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