782598 Clinical Documentation Improvement Specialist OptumCare Arizona WellMed Phoenix AZ

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Clinical Documentation Improvement Specialist - OptumCare Arizona - Phoenix, AZ (782598)

Position Description

The Clinical Documentation Improvement Specialist (CDIS) demonstrates experience by correlating coding accuracy with correct HCC assignment.  The CDIS is responsible for conducting the audit to improve and increase members annual funding in order to drive better patient care and assist providers through education and training to improve RAF scores. The CDIS will comply with Coding and Corporate Compliance standards. Abides by ethical standards and adheres to official coding guidelines. The CDIS will perform other duties as assigned.  The individual in this role will perform the crucial task of assuring accuracy of codes from the listing of International Classification of Diseases, Ninth Revision; (ICD-10 CM).  Must have good Organizational skills and communication skills.  Must have an excellent understanding of medical terminology, disease process and anatomy and physiology.  Must be task oriented and able to meet designated deadlines, productivity standards and able to work independently.
Primary Responsibilities: 
  • Conducts chart review of OptumCare of Arizona members - accomplished by traveling to the individual practices (185 Total) and performing the audit onsite
  • Conducts physician chart audits (including research and presentation). Assesses and interprets whether the coding assigned by the client was properly assigned based upon review of the medical documentation and application of the coding guidelines
  • Rely upon independent judgment and decision making while at a provider site, whether conducting an audit or providing training/education, both from historical and / or real time data
  • Able to field any questions or concerns and provide solutions that will mirror management’s guidelines
  • Implement education, and provide formal training to Lifeprint providers and staff as needed regarding coding compliance, documentation guidelines, usage of CCA long and short form, HCC education and Medicare/Medicaid regulations by proactively providing solutions to meet the needs of the Lifeprint provider
  • Enhance professional growth and development through in-service meetings, and educational programs
  • Work independently and rely on professional discretion and judgment; as well as a professional representation of Lifeprint
  • Utilize management for escalation purposes
  • Maintain strictest confidentiality based on HIPPA privacy policy
  • Available to assist other team members in coding, HCC opportunities and act as a resource to less experienced staff
  • Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM book, and other pertinent materials
  • Assists the Manager of Clinical Quality & Coding, with research, analysis, and response to inquiries regarding compliance, coding, and inappropriate coding
  • Provide feedback and present solutions, to the Manager of Clinical Coding and Quality, regarding trends or patterns noticed in provider coding
  • Schedule audits and provide patient lists to practice managers to promote a smooth audit process
  • CQA will perform tasks offsite and onsite, as scheduling can involve time out of the regular core hours; this function can account for up to 20% of the CQA time
  • Finalizing documentation and providing feedback to team members based on findings. This function can account for approximately 5% of the CQA time
  • Create Policy and Procedures to be used within the department to support Best Practices
  • Performs related work and projects as required
Required Qualifications:
  • High School Diploma and / or GED
  • 3+ years of experience / working knowledge of CMS Risk Adjustment and HCC Coding preferably in a Managed Care Setting
  • 3+ years experience of utilizing ICD-10 CM coding classification and guidelines
  • Must have completed coding certification course via AAPC / AHIMA 
  • Must possess a CPC certification 
  • Must have proficiency in all Microsoft Programs (i.e. Word, Excel and Outlook)  
  • 1+ years of Customer Service skills in a health care setting
  • Ability to travel locally to provider practices (75%) in Phoenix area
  • Proficient in Microsoft Office (e.g. Word, Excel, Outlook)
  • Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area 
Preferred Qualifications:
  • Supervisory experience a plus

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.



Job Keywords: CPC, Chart Review, AHIMA, AAPC, ICD-10, Risk Adjustment, HCC, Phoenix, AZ, Arizona

  • Requisition Number782598
  • Job TitleClinical Documentation Improvement Specialist - OptumCare Arizona - Phoenix, AZ
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumCare

Job Location Information

  • Phoenix, AZ
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt