Clinical Documentation Integrity Specialist - Hybrid - Las Vegas, NV

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.

About the role

The Clinical Document Integrity Specialist (CDIS) 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 use the Optum™ CDI 3D technology that assists 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, helps 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: Hybrid - St. Rose Dominican Hospital, Las Vegas, NV. This position follows a hybrid schedule with three in-office days per week.

Weekend Coverage: Friday - Tuesday

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 rationale 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 meetings 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

Requirements

• 2+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
• Experience communicating & working closely with Physicians
• Proficiency using a PC in a Google environment and Electronic Medical Records
• Willing to work weekend coverage, Friday - Tuesday - 8-hour days
• Willing to be onsite at St. Rose Dominican Hospital, Las Vegas on a hybrid schedule

Preferred Qualifications

• BSN degree if a RN
• CCDS, CDIP, or CCS certification
• Experience in Clinical Documentation Improvement
• CAC experience (Computer Assistant Coding)

Benefits

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).

Pay

The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.