Clinical Documentation Integrity Specialist

UnitedHealth Group • Plymouth, MN

105d • $58,800 - $105,000 • Remote

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 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. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

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

Nice To Haves

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

Responsibilities

• Perform concurrent and retrospective chart reviews for improving the overall completeness of clinical documentation
• Keep abreast of current coding trends and maintain 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
• Ensure 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 consultations 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

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree