Clinical Document Improvement Specialist

About the Role

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality, and revenue growth.

The Clinical Document Improvement Specialist (CDS) provides CDI program oversight and day-to-day implementation of processes related to the concurrent review of clinical documentation in the inpatient medical record of Optum 360 clients' patients. The goal is to assess the technical accuracy, specificity, and completeness of provider clinical documentation, ensuring it explicitly identifies all clinical findings and conditions present at the time of service. This role collaborates with providers and other healthcare team members to improve documentation accuracy, reflecting clinical treatment, decisions, and diagnoses for the patient.

The CDS utilizes clinical expertise, CDI best practices, and facility-specific tools, including Optum™ CDI 3D technology, to enhance data quality, ensure revenue integrity, and support compliance. This three-dimensional CDI approach improves efficiency, effectiveness, and the transition to ICD-10 by enhancing documentation specificity and completeness.

• Increase in identification of cases with CDI opportunities through 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 documentation specificity and completeness, resulting in more accurate coding

This position does not involve patient care duties, direct patient interactions, or any role relative to patient care. Work location is onsite at the client hospital.

Responsibilities

• Provides expert-level review of inpatient clinical records within 24-48 hours of admission; identifies gaps in clinical documentation requiring clarification for accurate code assignment to reflect 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 conducting proficient reviews, articulating recommendations, and explaining the rationale for improvements
• Actively communicates with providers at all levels to clarify information and convey 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
• Ensures complete follow-through on all requests for clarification or recommendations for improvement
• Leads the development and execution of physician education strategies to improve 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 Optum360-approved clarification forms
• Proactively develops reciprocal relationships with HIM Coding Professionals
• Coordinates and conducts regular meetings with HIM Coding Professionals to reconcile DRGs, monitor retrospective query rates, and discuss coding and CDI-related questions
• Engages and consults with Physician Advisor/VPMA as needed, per the escalation process, to resolve provider issues regarding clarifications and participation in the CDI process
• Actively collaborates with Care Coordination and Quality Management teams to evaluate and spearhead clinical documentation improvement opportunities

Requirements

• 3+ years of acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
• Experience communicating and working closely with physicians
• Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, PowerPoint, and Electronic Medical Records

Preferred Qualifications

• BSN degree (if a Registered Nurse)
• CCDS, CDIP, or CCS certification
• Experience in Clinical Documentation Improvement
• Computer-Assisted Coding (CAC) experience

Pay

Pay is based on several factors, including but not limited to local labor markets, education, work experience, and certifications. The hourly pay for this role ranges from $35 to $63 per hour based on full-time employment.

Benefits

In addition to salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).