[Hiring] Clinical Documentation Improvement Specialist @UnitedHealth Group

Role Description

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 utilize 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.

• 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 utilize ICD-10 and related materials to investigate coding issues and produce accurate results
• Conduct daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
• Provide 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
• Actively communicate 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
• Provide complete follow-through on all requests for clarification or recommendations for improvement
• Ensure effective utilization of Optum® CDI 3D Technology to document all clarification activities
• Utilize only the Optum360 approved clarification forms
• Proactively develop a reciprocal relationship with the HIM Coding Professionals
• Engage and consult 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.

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, PowerPoint, and Electronic Medical Records

Requirements

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

Benefits

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