Clinical Documentation Improvement Specialist - Remote

Optum; Los Alamitos (CA); Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Optum is seeking a Clinical Documentation Improvement (CDI) Specialist to review inpatient records and guide physicians toward evidence-based coding in a remote role across the U.S. The position emphasizes collaboration with Care and Quality teams and requires strong communication with physicians.

You'll work from anywhere in the U.S., with competitive compensation and benefits. RN or MD candidates with CDI experience are encouraged to apply.

Qualifications

• Undergraduate degree or equivalent experience.
• Current RN License or Medical School Graduate.
• For RN: 3+ years acute inpatient CDI experience.
• For Medical School Graduates: 2+ years acute inpatient CDI experience.
• Experience communicating and working closely with Physicians.
• Experience performing concurrent inpatient chart reviews and physician query processes.
• Experience with ICD-10-CM/PCS documentation requirements.
• Knowledge of inpatient reimbursement methodologies including MS-DRG and APR-DRG systems.
• Proficiency with Windows, Microsoft Word, Excel, and Electronic Medical Records.

Responsibilities

• Provides expert level review of clinical records within 24-48 hours of admission; reviews clinical documentation to ensure consistency with guidelines.
• Conducts clear communication to providers to reinforce evidence-based guidelines.
• Tracks productivity for accurate reporting of indicators and analyses.
• Leads improvement in clinical documentation with recommendations and rationale.
• Provides educational opportunities for physicians and health care team members.
• Completes follow through on requests for clarification or recommendations.
• Participates in education strategy development for improved documentation.
• Offers timely feedback to providers on opportunities for improvement.
• Engages with Medical Director and leadership to resolve clarifications as needed.
• Collaborates with Care Coordination and Quality Management to drive CDI opportunities.
• Works with less structured, complex issues and serves as a resource to others.

Skills

Physician communication

Concurrent chart reviews

ICD-10-CM/PCS

MS-DRG knowledge

Documentation guidelines

Windows proficiency

Education

Undergraduate degree or equivalent

RN license

Medical School Graduate

Tools

MS Word

MS Excel

EMR systems

Job description

For those who want to invent the future of health care, here's your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Jobs in this function provide coding and coding auditing services directly to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

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

Primary Responsibilities

• Provides expert level review of clinical records within 24-48 hours of admission; reviews clinical documentation to ensure consistency and alignment with evidence-based guidelines
• Conducts clear communication to providers to reinforce evidence-based guidelines are being followed
• Effectively tracks productivity to allow for accurate/timely reporting of leading indicators and future impact analyses
• 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 rationale for the recommendations
• Provides educational opportunities for physicians and other health care team members
• Provides complete follow through on all requests for clarification or recommendations for improvement
• Participates in the development and execution of education strategies resulting in improved clinical documentation
• Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Engages and consults with Medical Director/leadership when needed, per the escalation process, to resolve issues regarding answering clarifications and participation in the clinical documentation improvement process
• Actively engages with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities
• Generally work is self-directed and not prescribed
• Works with less structured, more complex issues
• Serves as a resource to others

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

Required Qualifications

• Undergraduate degree or equivalent experience
• Current RN License or Medical School Graduate
• For RN: 3+ years acute inpatient CDI experience
• For Medical School Graduates: 2+ years of acute inpatient CDI experience
• Experience communicating & working closely with Physicians
• Experience performing concurrent inpatient chart reviews and physician query processes
• Experience working with ICD-10-CM/PCS documentation requirements
• Knowledge of inpatient reimbursement methodologies including MS-DRG and APR-DRG systems
• Knowledge of documentation regulations, compliant query practices, and coding guidelines
• Basic proficiency using a PC in a Windows environment, including Microsoft Word, Excel, and Electronic Medical Records

Preferred Qualifications

• If RN, BSN degree
• Current certification as a CCDS, CDIP or CCS
• Proven excellent verbal and written skills including solid organizational skills
• All employees working remotely 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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

OptumCare 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.

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