Optum
Clinical Documentation Integrity (CDI) Specialist
This role focuses on performing concurrent and retrospective chart reviews to improve the completeness of clinical documentation. It involves working closely with providers and interdisciplinary teams to clarify documentation, apply coding guidance, and support clinical documentation integrity efforts.
Key Responsibilities
- • Perform concurrent and retrospective chart reviews for improving the overall completeness of clinical documentation
- • Keep abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI trends
- • Effectively utilizes ICD-10 and related materials to investigate coding issues and produce accurate results
- • Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
- • Provides expert level leadership for overall improvement in clinical documentation by providing proficient review and assessment, and effectively articulating recommendations for improvement including the rationale for the recommendations
- • Actively communicates 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
- • Provides complete follow through on all requests for clarification or recommendations for improvement
- • Ensures effective utilization of Technology to document all clarification activity
- • Collaborates closely with interfacing departments such as Care Coordination and Quality.
- • Utilizes only the Optum/client approved clarification forms
- • Proactively develops a reciprocal relationship with the HIM Coding Professionals
- • Engages and consults with Physician Advisor/CMO when needed, per the hospital defined escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation integrity process
Required
- • Undergraduate degree or equivalent experience.
- • 5+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience
- • Advanced proficiency in clinical medicine, pathophysiology, and pharmacology
- • Advanced proficiency communicating & working closely with Physicians
- • Intermediate proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
Preferred
- • Experience interacting with Providers providing concurrent/chart review
- • Proven comfortable with technology
Benefits & Perks
- • a comprehensive benefits package
- • incentive and recognition programs
- • equity stock purchase
- • 401k contribution
- • a far-reaching choice of benefits and incentives
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This position follows a hybrid schedule with four in-office days per week.
Primary Responsibilities
Required Qualifications
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.
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.
This position follows a hybrid schedule with four in-office days per week.
Primary Responsibilities
- Perform concurrent and retrospective chart reviews for improving the overall completeness of clinical documentation
- Keep abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI trends
- Effectively utilizes ICD-10 and related materials to investigate coding issues and produce accurate results
- Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
- Provides expert level leadership for overall improvement in clinical documentation by providing proficient review and assessment, and effectively articulating recommendations for improvement including the rationale for the recommendations
- Actively communicates 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
- Provides complete follow through on all requests for clarification or recommendations for improvement
- Ensures effective utilization of Technology to document all clarification activity
- Collaborates closely with interfacing departments such as Care Coordination and Quality.
- Utilizes only the Optum/client approved clarification forms
- Proactively develops a reciprocal relationship with the HIM Coding Professionals
- Engages and consults with Physician Advisor/CMO when needed, per the hospital defined escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation integrity process
Required Qualifications
- Undergraduate degree or equivalent experience.
- 5+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience
- Advanced proficiency in clinical medicine, pathophysiology, and pharmacology
- Advanced proficiency communicating & working closely with Physicians
- Intermediate proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
- Experience interacting with Providers providing concurrent/chart review
- Proven comfortable with technology
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.
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.
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