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Physician Documentation Improvement Specialist (CDI)- Work at Home Potential - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Philadelphia, PA Philadelphia, Pennsylvania |
About this job
Talk about meaningful work. Talk about an important role. Let's talk about your next career move. If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
The Physician Documentation Improvement Specialist performs medical record reviews, examining and assessing all patient documentation to ensure that all information including the diagnosis is accurate. This is accomplished by a concurrent and retrospective review of medical records. The individual is responsible for the validation of diagnosis codes and the identification of missing diagnosis so that patient severity of illness is properly reflected in the medical record. The PDI Specialist will collaborate with interdisciplinary teams including, but not limited to, physicians, nurses, PA's, and Coders. Assumes responsibility for professional development by participating in workshops, conferences, and/or in-services and maintains appropriate records of participation.
Multiple opportunities available
Client facing and internal facing roles
Client travel as needed
Primary Responsibilities:
- Conducts an extensive analysis of patient records (e.g. chart review) to evaluate documentation of principal diagnosis and all applicable secondary diagnoses
- Obtains and promotes appropriate physician documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and coding staff to ensure that the documentation of the level of service rendered to the patient and the patient's clinical complexity is complete and accurate
- Links ICD-9-CM coding guidelines and medical terminology to improve accuracy of patient severity of illness, risk of mortality and final code assignment
- Reviews medical record to ensure that diagnoses are reported in accordance with CMS payment guidelines
- Maintains working relationships with physicians and other hospital staff members
- Establish and maintain effective working relationships with both internal/external physicians and hospital staff
- Interpret, adapt, and apply guidelines and procedures
- Analyze complex clinical scenarios and apply critical thinking
Requirements
Required Qualifications:
- RN or Coder (Registered Nurse license (RN), Registered Health Information Administrator certification (RHIA), Registered Health Information Technician certification (RHIT), Certified Coding Specialist certification (CCS) or CCDS)
- Subject matter expertise in clinical documentation improvement
- Advanced clinical expertise and extensive knowledge of complex disease processes with broad based clinical experience in an inpatient setting
- 5+ years of one of these three areas: clinical chart review experience OR Hierarchal Condition Categories (HCC) audits OR ICD-9-CM coding application on medical record review
- Extensive knowledge of ICD-9-CM/CPT coding
Two positions available. One on the implementation side has work at home potential and travel to our clients. One on the delivery side will be working along-side our in-house physicians in the home office but can also work remotely.
Broad knowledge of insurance regulations and Medicare and Medicaid guidelines
Proficient in communicating clearly and effectively with multiple constituents
Extensive knowledge of reimbursement systems
Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation and coding
Extensive knowledge of treatment methodology, patient care assessment, data collection techniques and coding classification systems is necessary
Executive Health Resources is part of the expanding and widely respected Optum family of businesses. As an Optum company, we're contributing to the growth and industry shaping influence of UnitedHealth Group throughout the US and the world. You will not find a group of professionals with more character, more energy, more brainpower or more opportunities to use all three.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Keywords: Clinical, RN, RHIA, RHIT, CCS, CCS-P, CPC, CPC-H, ICD-9 CM, CCDS, ICD-9 PCM, ICD-10, CDI, CDIP, ACDIS, DRG, inpatient, medical coder, coder, chart review, hospital, hospital medical coder, Philadelphia, PA Executive Health Resources
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