[Hiring] Clinical Documentation Improvement Specialist @UnitedHealth Group

Role Description

This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am – 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of training will be aligned with your schedule.

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

Primary Responsibilities:

• Perform DRG validation reviews and confirm appropriate diagnosis related group (DRG) assignments.
• Maintain current working knowledge of ICD-10 coding principles and CMS regulations.
• Investigate, review, and provide clinical and/or coding expertise/judgment in the application of medical and reimbursement policies within the claim adjudication process through medical records review.
• Serve as a Subject Matter Expert (SME), performing medical record reviews to include quality audits, as well as validation of accuracy and completeness of all coding elements, and medical necessity reviews.
• Responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development.
• Serve cross-functionally with Medical Directors, and sometimes Utilization Management, as well as other internal teams to assist in identification of overpayments.
• Serve as a SME for all Payment Integrity functions to include both Retrospective Data Mining, as well as Pre-Payment Cost Avoidance.
• Identify trends and patterns with overall program and individual provider coding practices.
• Support the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable opportunity.

Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• Certified coder with AHIMA or AAPC ex. RHIA, RHIT, CPC, CIC
• 5+ years of experience in the health insurance industry
• 2+ years of experience with health insurance claims
• 2+ years of experience with inpatient DRG coding
• 2+ years of experience with medical records review
• 2+ years of facility claims experience
• Proficiency in performing financial analysis / audits including statistical calculation and interpretation
• Ability to work Monday - Friday, during our normal business hours of 7:00 am - 5:00 pm CST.

Preferred Qualifications

• Registered Nurse
• 2+ years of experience in Utilization Management
• Experience working with federal contracts
• CES (Claims Editing System) SME, or SME in another clinical claims editing system

Telecommuting Requirements

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

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.