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Clinical Documentation Improvement Specialist - Bronx / Manhattan, NY

UnitedHealth Group

Bronx, NY
Job Code:
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Job Details

728709 Clinical Documentation Improvement Specialist Bronx Manhattan NY

Clinical Documentation Improvement Specialist - Bronx / Manhattan, NY (728709)

Position Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The Clinical Documentation Improvement Specialist (CDIS) conducts medical record documentation and coding quality reviews to ensure correct coding and documentation of encounter data for Risk Adjustment and Fee for Service product lines. The CDIS also recommends processes for accurate coding and documentation practices through communication and education with their assigned provider teams to ensure compliance with federal regulations, statutes, and the Office of Inspector General.


***This position will be traveling to 2 boroughs - Bronx and Manhattan.  Office is based at W 34th Street in Manhattan and traveling to skilled nursing facilities in both Manhattan and Bronx.***


Primary Responsibilities:

  • Performs onsite concurrent coding quality reviews for provider charts as well as other teams as needed

  • Evaluates documentation to ensure that diagnosis coding is supported and meets specificity requirements for accurate submissions

  • Queries providers regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the heath record

  • Provides coaching and feedback and develops targeted education and training to provider teams to improve accuracy

  • Provide ICD10-CM coding training, as it relates to HCC coding, as requested

  • Develops relationships with clinicians and communicates guidelines and requirements of Risk Adjustment Payment System to ensure correct coding and documentation

  • Develops relationships with clinical providers and communicates coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation

  • Maintains a 95% quality audit accuracy rate

  • Takes direction and guidance from Supervisor of the Risk Adjustment Coding and Documentation Improvement Specialist and the Manager of the Risk Adjustment Coding and Documentation Improvement Program


Required Qualifications:

  • HS Diploma or higher or significant equivalent work experience (3+ years)
  • Coding Certification from AAPC or AHIMA, (CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P) OR LPN willing to obtain coding credential from AAPC or AHIMA within 12 months of hire
  • 3 years active coding experience with ICD diagnosis coding

  • 1 year experience as ICD coding Auditor
  • Minimum 1 year CMS Risk Adjustment – HCC Coding/Auditing Experience

  • Requires strong verbal/written communication and interpersonal skills

  • Must have the ability to perform in a deadline driven environment

  • Must be able to maintain professionalism and a positive service attitude at all times

  • Ability to analyze facts and exercise sound judgment when arriving at conclusions

  • Ability to effectively report deficiencies with a recommended solution in oral and/or written form

  • Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook

  • Commuter expenses reimbursable

Preferred Qualifications:

  • Associates Degree
  • Clinical Documentation Improvement Specialist Credential AHIMA or ACDIS
  • Certification as Certified Risk Adjustment Coder (CRC)

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: Bronx, Manhattan, risk, adjustment, documentation, improvement specialist, coding, audit, medicare, CMS, HEDIS, Optum, risk adjustment, CCS, CPC, RHIT, CCS-P, ICD-10, CRC, STARS, HCC, CDIS, Clinical Documentation Improvement Specialist

Job Details

  • Contest Number728709
  • Job TitleClinical Documentation Improvement Specialist - Bronx / Manhattan, NY
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumCare

Job Location Information

  • Bronx, NY
    United States
    North America
  • Other LocationsManhattan, NY

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 50 % of the Time
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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