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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 as well as facility specific tools for best practice and compliance.
• Utilize the Optum™ CDI 3D technology to improve data quality and ensure revenue integrity.
• 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 to resolve provider issues.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role.

Qualifications

• Proven solid understanding of clinical medicine, pathophysiology, and pharmacology.
• Demonstrated 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

• CCDS, CDIP or CCS certification (preferred).
• 5+ years of experience with acute inpatient hospital coding with certifications (preferred).
• 5+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP) (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).

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.