Integrity Specialist

5 days ago

East St Louis, United States UnitedHealth Group Full time
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 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 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 utilize 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.

If you are located in the St. Louis Region, you will have the flexibility to telecommute,* as well as attend on-site meetings and education sessions as you take on some tough challenges.

Primary Responsibilities:
  • Provides expert level review of inpatient clinical records within 24-48 hours 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 daily 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 verbal, written, electronic 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 reconcile 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:
  • 3+ years of acute care hospital clinical RN experience, OR Foreign Medical Graduate with CDI experience
  • Experience in Clinical Documentation Improvement
  • Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point, and Electronic Medical Records
  • Experience communicating & working closely with Physicians
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

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