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Job Details

UnitedHealth Group

Clinical Documentation Improvement Specialist-Telecommute




Columbia, Maryland, United States

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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do 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 NPCCR or IPCCR CDIS supports the Advanced Practice Clinician through documentation and coding quality reviews, recommending accurate practices through communication and education to ensure complete coding and documentation of encounter data, and excellent customer service delivery for Risk Adjustment Clinical Programs. This program supports newly hired clinicians as well as incumbent clinicians who may require additional support and coding education.

Reports to: NPCCR Coding Manager

Service Delivery - Ensures documentation and coding submissions for Risk Adjustment are of high quality and reflect an accurate member health record
Customer Service - Provides excellent customer service to internal and external customers
Liaison and Communication/Teamwork‐ Promotes a team environment and enhances partnership/collaboration through effective communication

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

Primary Responsibilities:

  • Coding Quality Activities:
    • 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% concurrent coding quality reviews, to include logging and reporting of coding audit outcomes for newly hired and incumbent APCs (NP, PA, MDs) until the provider achieves 95% coding accuracy rate
      • 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
    • Performs Coding Audits in accordance with department policies providing expert coding and
    • documentation coding education, timely feedback, coaching, fostering an environment of learning to CCM’s Clinicians (APC)
    • 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
    • Identifies Clinical Indicator Suspect conditions for referral to the CDIS Suspect program
    • Queries providers regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the heath record
    • Education Activities:
      • Serves as the APC’s coding “mentor/preceptor” and works one on one with their Assigned APCs providing regular feedback and communication regarding coding accuracy and documentation gaps
      • Performs weekly analysis of Coding outcomes and submits formal written performance reports to assigned APCS on a weekly basis (Provider Progress Reporting)
      • Schedules meetings with assigned APCs and delivers one‐on‐one feedback sessions to include review of outcomes and performance
      • Provides coaching and feedback and develops targeted education to provider teams
    • Other Activities:
      • Develops relationships with clinical providers and communicates coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
      • Communicates program graduation notifications to APC as well as APC’s manager
      • Maintains a 96% quality audit accuracy rate
      • Performs the minimum number of coding quality reviews consistent with established departmentalgoals
      • Communicates with Coding Manager, CCM Coding SMES, APC Educator to address coding and documentation issues, trends, and gaps.

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 AACP 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
  • 5 years of active coding experience with ICD diagnosis coding
  • 3 years of Risk Adjustment HCC/Coding/Auditing Experience
  • 2 years experience in a coding auditor/educator or mentor role
  • Experience developing and delivery coding education/training to professionals such as physicians, nurses, nurse practitioners etc.
  • Advanced understand of medical terminology, pharmacology, anatomy and physiology, and pathophysiology
  • Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook

Preferred Qualifcations:

  • Certification as Certified Risk Adjustment Coder
  • Experience or Certification as Clinical Documentation Improvement Specialist
  • Exemplary attention to detail and completeness with a thorough understanding of CMS regulations and thorough understanding of potential areas of risk for fraud and abuse in regard to coding and documentation
  • Solid verbal/written communication and interpersonal skills
  • Ability to perform in a deadline driven environment
  • Ability to always maintain professionalism and a positive service attitude
  • Ability to analyze facts and exercise sound judgment when arriving at conclusions
  • Ability to effectively report deficiencies with a recommended solution in oral and/or written form
  • Demonstrate Critical Thinking when making decisions
  • Ability to be an exemplar of the mission, values, culture, and philosophy of the enterprise

CLL‐ Practices for Success ‐ IC

  • Resilience & Resourcefulness
  • Managing Ambiguity & Uncertainty
  • Communicating with Others
  • Collaborating
  • Serving Customers
  • Influencing Others
  • Achievement Drive
  • Building & Applying Technical/Functional Skills
  • Using Time & Resources Effectively
  • Critical Thinking
  • Supporting Innovation and Creativity
  • Solving Problems
  • Delivering Results

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, 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 with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut / Nevada residents is $28.85 to $51.30. 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.

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

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.