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Role Description

The Clinical Document Integrity 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.

• Review all clinical information and documentation to make improvements that result in accurate, comprehensive documentation.
• Utilize clinical expertise and clinical documentation improvement practices.
• Use facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum 360.
• Utilize the Optum™ CDI 3D technology to assist hospitals in improving data quality.
• Increase identification of cases with CDI opportunities, with automated review of 100% of records.
• Improve 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.

This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

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.
• Actively communicate with providers at all levels to clarify information and communicate documentation requirements.
• 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 activity.
• 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.

Qualifications

• BSN required if you possess an RN license.
• CCDS or CDIP certification or willing to obtain within 6 to 12 months.
• 5+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP).
• 3+ years of CDI experience for an acute care hospital.

Preferred Qualifications

• CCS Certification.
• CAC experience (Computer Assistant Coding).
• Strong understanding of clinical medicine, pathophysiology, and pharmacology.
• Solid grasp of 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.

Requirements

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

Benefits

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.
• 401k contribution (all benefits are subject to eligibility requirements).

The salary for this role will range from $60,200 to $107,400 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.

Company Description

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.

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.