Clinical Documentation Improvement Specialist, (CDIS) Telecommute - 2020665

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) 

The Clinical Documentation Improvement Specialist (CDIS) serves as a coding and documentation consultant to Optum’s Complex Care Management with the objective of providing efficient, effective, accurate, and timely clinical coding services. The CDIS supports the Advanced Practice Clinician through continuous documentation and coding quality reviews to ensure accurate and complete coding and documentation of encounter data, and excellent customer service delivery for Risk Adjustment Clinical Programs.

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

Primary Responsibilities:

Provides expert level review of submitted visit notes; identifies gaps in clinical documentation that require clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the condition

Audits Provider submitted ICD-CM codes, in accordance with Risk Adjustment documentation and coding standards

Performs 100% Comprehensive concurrent coding quality reviews, to include the logging and reporting of coding audit outcomes for providers in each market as assigned by region, which includes: Review and validation of ICD code submissions for accuracy and compliance with Risk Adjustment standards Review and analysis of clinical documentation for missed coding opportunities Review and analysis for suspect conditions based on clinical indicators and documentation findings Review and analysis for quality indicators including HEDIS metrics per client requirements

Queries providers regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the heath record

Communicates with Coding Manager, CCM Coding SMES, APC Educator to address coding and documentation issues, trends, and gaps

Identifies Clinical Indicator Suspect conditions for referral to the CDIS Suspect program

Maintains a 96% quality audit accuracy rate

Performs the minimum number of coding quality reviews consistent with established departmental goals

Completes Quality Audit Outcome Form, logging audit outcomes for each ICD-10-CM code assessed, adding ICD-10-CM codes identified as Missed, and adding conditions identified as “Clinical Indicator Suspects” referred to CDIS Suspect program

In accordance with Coding Manager, participates in the development and distribution of the monthly market Coding Quality Outcomes report

As requested, participates in the monthly CCM regional SME Educational sessions

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 as well as provide development for other roles you may be interested in.

Required Qualifications:

Associates degree or higher or equivalent work experience

Coding Certification from AAPC or AHIMA professional coding association (Example: CPC, CPC-H, CPC-P, RHIT, RHIA, CCA, CCS, CCS-P, CRC) or RN/LPN with ability to obtain coding certification from AHIMA or AAPC within 12 months of hire

3+ years of active coding experience with ICD diagnosis coding

1+ years of active CMS HCC Coding Risk Adjustment Experience

Knowledge of clinical conditions, procedures, and basic documentation requirements

Proven ability to perform in a deadline driven environment

Demonstrated ability to maintain professionalism and a positive service attitude

Proven ability to analyze facts and exercise sound judgment when arriving at conclusions

Proven ability to effectively report deficiencies with a recommended solution in oral and/or written form

Demonstrate Critical Thinking when making decisions

Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint

Preferred Qualifications:

Certification as Certified Risk Adjustment Coder

Experience or Certification as Clinical Documentation Improvement Specialist

Solid verbal/written communication and interpersonal skills

Exemplar of the mission, values, culture, and philosophy of the enterprise

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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

Colorado, Connecticut or Nevada Residents Only : The salary/hourly range for Colorado residents is $20.77 to $36.88. The salary/hourly range for Connecticut/Nevada residents is $22.93 to $40.58. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.