Clinical Document Integrity Specialist - Bakersfield, CA - Onsite

Clinical Document Integrity Specialist - Bakersfield, CA - Onsite at UnitedHealth Group summary :

The Clinical Document Integrity Specialist oversees the clinical documentation improvement (CDI) program to ensure inpatient medical records are accurate, specific, and complete. This role collaborates with healthcare providers and coding professionals to enhance documentation quality, optimize health outcomes, and improve hospital revenue integrity using specialized technology. The specialist provides education, conducts reviews, and leads efforts to maintain compliance and improve clinical documentation processes within acute care settings.

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.

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.

This position collaborates with providers and other healthcare team members to make improvements that result in accurate, comprehensive documentation that reflects completely, the clinical treatment, decisions, and diagnoses for the patient. The CDS utilizes clinical expertise and clinical documentation improvement practices as well as facility specific tools for best practice and compliance with the mission / philosophy, standards, goals, and core values of Optum 360.

In this position the CDS will utilizing the Optum CDI 3D technology that is assisting hospitals to improve data quality to accurately reflect the quality of care provided and ensure revenue integrity.

Our three-dimensional approach to CDI technology, paired with best-practice adoption methodology and change management support, is helping hospitals make a real impact on CDI efficiency and effectiveness.

Increase in identification of cases with CDI opportunities, with automated review of 100% of records

Improved 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, resulting in more accurate coding

This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

• Work Location : Bakersville Memorial Hospital

You'll enjoy the flexibility to work remotely

Primary Responsibilities :

Provides expert level review of inpatient clinical records withinhours of admit; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the condition and acuity of care provided

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 level review and assessment, and effectively articulating recommendations for improvement, and the rational 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

Performs regular rounding with unit-based physicians and provides Working DRG lists to Care Coordination

Provides face-to-face educational opportunities with physicians on a regular basis

Provides complete follow through on all requests for clarification or recommendations for improvement

Leads the development and execution of physician education strategies resulting in improved clinical documentation

Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes

Ensures effective utilization of Optum CDI 3D Technology to document all clarification activity

Utilizes only the Optum360 approved clarification forms

Proactively develops a reciprocal relationship with the HIM Coding Professionals

Coordinates and conducts regular meeting with HIM Coding Professionals to reconsolidate DRGs, monitor retrospective query rates and discuss questions related to Coding and CDI

Engages and consults with Physician Advisor / VPMA when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process

Actively engages with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities

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 :

5+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)

Demonstrated proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and electronic medical records

Experience communicating & working closely with Physicians

Ability to work onsite at the Bakersfield Memorial Hospital in Bakersfield, CA

Preferred Qualifications :

BSN degree if a RN

CCDS, CDIP or CCS certification

Experience in Clinical Documentation Improvement

CAC experience (Computer Assistant Coding)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

Compensation Information :

$71200.00 / annually - $127200.00 / annually