Clinical Documentation Integrity & Utilization Review Specialist

Avera Health • Sioux Falls, SD

29d • $29 - $44

About The Position

Provides vital administrative and operational support to ensure the efficiency and effectiveness of CDI and UR programs. This role is instrumental in maintaining seamless daily workflows by coordinating documentation processes, managing denial tracking, and supporting clinical teams with non-clinical tasks. By handling essential administrative responsibilities, the Specialist enables clinical staff to concentrate on work requiring clinical decision-making.

Requirements

• The individual must be able to work the hours specified.
• To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
• These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
• 3-5 years working in healthcare or in a health system
• Familiarity with medical terminology and healthcare documentation

Nice To Haves

• Associate's
• Bachelor's

Responsibilities

• Coordinates daily administrative tasks to facilitate collection, organization and distribution of clinical documentation to support CDI/UR workflows.
• Clinical Denial Management support: tracks, monitors, coordinates and assists with routing of clinical denials to internal stakeholders as well as external payers/auditors.
• Communication liaison for the clinical teams related to exchange and issue resolution as well as communicating non-clinical functions to the payers to assist with compliance to payer policies.
• Assists as the primary liaison to management for identifying, documentation and escalating workflow inefficiencies or opportunities for improvement.
• Proactively monitors operations to determine patters or issues that require further collaboration to enhance overall program performance.

Benefits

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees