Clinical Documentation Integrity Specialist

Position Location : St. Louis, Missouri

(Need to be onsite for meetings)

The

Clinical Document Integrity Specialist

(CDS) is responsible for day-to-day CDI implementation related to the concurrent review of clinical documentation in inpatient medical records for Optum 360 clients. The goal is to assess the accuracy, specificity, and completeness of provider documentation, ensuring all clinical findings and conditions are explicitly identified.

This role collaborates with healthcare providers and team members to improve documentation quality, reflecting clinical treatment, decisions, and diagnoses. The CDS utilizes clinical expertise, documentation improvement practices, and facility-specific tools to ensure compliance with Optum 360's standards and values.

The position involves using the Optum CDI 3D technology to enhance data quality, reflect care quality, and maintain revenue integrity. Our three-dimensional CDI approach, combined with best practices and change management, aims to improve CDI efficiency and effectiveness.

Key benefits include :

• Increased identification of CDI opportunities through automated record review
• Enhanced tracking, transparency, and reporting on CDI impact, revenue, and compliance
• Smoother ICD-10 transition by improving documentation specificity and completeness

This role does not involve direct patient care or interaction.

Remote work flexibility is available for those in the St. Louis region, with on-site meetings and education sessions as needed.

Primary Responsibilities :

We recognize performance and offer a challenging environment with clear success pathways, development opportunities, and recognition.

Required Qualifications :

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