Clinical Documentation Integrity Specialist RN

UnitedHealth Group; Massachusetts; In loco; USD 40.000 - 72.000; Tempo pieno

Descrizione del lavoro

UnitedHealth Group is seeking a Clinical Documentation Integrity Specialist RN in Worcester, MA. The role focuses on accurate clinician documentation and risk adjustment through concurrent and retrospective abstraction within Reliant programs.

Required is a state-approved nursing education and 3+ years of chronic-disease nursing experience, with BLS certification and CPC/CCS-type credentials preferred. Full-time, on-site in Worcester, 40 hours weekly.

Competenze

• 3+ years of nursing experience with chronic disease patient populations.
• Experience in ambulatory or inpatient settings.
• Familiarity with CMS/Medicare coding concepts and documentation practices.

Mansioni

• Review encounters in the EMR to ensure accuracy of clinician documentation.
• Substantiate HCC diagnoses using abstract reports.
• Provide concurrent and retrospective abstraction for Reliant Risk Adjustment programs.
• Perform chart reviews for supporting documentation of diagnoses for the Problem List.
• Review new Reliant Medical Group patients for potential diagnoses supporting risk adjustment programs.
• Provide clinician training for risk adjustment programs with the coding education team.
• Develop and monitor procedures that support risk adjustment capture and organizational goals.
• Apply knowledge of ICD-10 and CPT coding regulations.

Conoscenze

Clinical documentation

Risk adjustment knowledge

Formazione

State-approved nursing program

Descrizione del lavoro

About This Role

As a Clinical Documentation Integrity Specialist RN, you will be responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and adhering to current standards of nursing practice. This role is ideal for those who excel in critical thinking and evidence-based nursing practice.

Highlights

• Pay: $29 - $52/hour
• Location: Worcester, MA
• Brand/Division: Optum
• Department/Unit: Population Health- Risk adjustment
• Schedule: Full time, 40HRS Weekly

What You'll Do

• Review encounters in the electronic medical record to ensure accuracy and appropriateness of clinician documentation.
• Utilize abstract reports to substantiate HCC diagnoses that have been billed and/or are considered relevant.
• Provide concurrent and retrospective abstraction for all Reliant Risk Adjustment programs.
• Conduct chart reviews for supporting documentation of diagnosis codes which can be added to the Problem List.
• Review new Reliant Medical Group patients for potential diagnoses supporting risk adjustment programs.
• Provide clinician training for risk adjustment programs with the coding education team.
• Participate in development, implementation, and monitoring of procedures that support organizational goals related to risk adjustment capture.
• Utilize thorough understanding of CMS/Medicare coding regulations and technical knowledge of ICD-10 and CPT systems.
• Perform other duties as assigned.

Requirements

Education

• Graduate of a State-approved school of nursing

Experience

• 3+ years nursing experience with at least 3 years of clinical experience with chronic disease patient populations in an ambulatory or inpatient setting

Licenses & Certifications

• Current, unrestricted license to practice professional nursing in the Commonwealth of Massachusetts
• Certification as professional coder (CPC, CCS-P, CCS, CPC-H, CRC-risk, AAPC) or ability to obtain certification while working in the position
• American Heart Association Basic Life Support (BLS)

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving the quality, cost, and experience of healthcare through innovation and superior care management.