Clinical Documentation Improvement Specialist

UnitedHealth Group; Phoenix (AZ); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Telecommuting option

Competitive benefits package

Job summary

UnitedHealth Group is seeking a Clinical Document Improvement Specialist (CDS) to oversee CDI programs and implement processes for inpatient chart reviews. The role aims to improve the technical accuracy and completeness of provider documentation using Optum 360 CDI 3D technology.

The CDS will collaborate with HIM teams and physicians, ensure compliance with CMS rules, and drive documentation improvements to support accurate coding and revenue integrity in a remote U.S. capacity.

Qualifications

• 3+ years of acute care hospital clinical RN experience or Medical Graduate with CDI experience.
• 2+ years in clinical medicine, pathophysiology, and pharmacology.
• 1+ years of ICD-10 coding experience and familiarity with coding guidelines.
• Proficient PC user in Windows environment with MS Office.

Responsibilities

• Perform concurrent and retrospective chart reviews to improve documentation completeness.
• Stay updated on Medicare rules and ICD-10 coding conventions.
• Investigate coding issues with ICD-10 materials and deliver accurate results.
• Communicate with providers to obtain documentation specificity and clarifications.
• Lead improvement efforts in clinical documentation and provide recommendations.

Skills

Acute care nursing

CDI experience

Windows PC skills

MS Word

MS Excel

MS PowerPoint

Education

Nursing RN license or MD

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

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 Document Improvement Specialist - (CDS) is responsible for providing CDI program oversight and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients' patients. The goal of the CDS oversight and 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 improvement practices as well as facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum 360. In this position the CDS will utilizing the Optum™ CDI 3D technology that is assisting hospitals to improve data quality to accurately reflect the quality of care provided and ensure revenue integrity.

Our three-dimensional approach to CDI technology, paired with best-practice adoption methodology and change management support, is helping hospitals make a real impact on CDI efficiency and effectiveness.

• Increase in identification of cases with CDI opportunities, with automated review of 100% of records
• Improved tracking, transparency and reporting related to CDI impact, revenue capture, trending, and compliance
• Easing the transition to ICD-10 by improving the specificity and completeness of clinical documentation, resulting in more accurate coding

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

Primary 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 current 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 level review and assessment, and effectively articulating recommendations for improvement, and the rational 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 Optum® CDI 3D Technology to document all clarification activities
• Utilizes only the Optum360 approved clarification forms
• Proactively develops a reciprocal relationship with the HIM Coding Professionals
• Engages and consults with Physician Advisor /VPMA when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• 3+ years of acute care hospital clinical RN experience or Medical Graduate with CDI experience
• 2+ years of experience in clinical medicine, pathophysiology, and pharmacology
• 1+ years of experience in ICD-10 coding, coding conventions, and guidelines
• Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records

Preferred Qualifications

• CCDS, CDIP or CCS certification
• 5+ years of acute inpatient hospital coding with certifications
• 3+ years of CDI experience for an acute care hospital
• CAC experience (Computer Assistant Coding)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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