Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Documentation Integrity Specialist is responsible for the day-to-day implementation of processes related to the review of inpatient medical records. This role is centered on assessing accuracy, specificity, and completeness of provider clinical documentation. The primary objective is to ensure that documentation explicitly identifies all clinical findings and conditions present at the time of service to accurately reflect the severity of the patient's condition and the acuity of care provided.
Please note that according to the sources, this position does not have patient care duties, direct patient interactions, or any role related to patient care.
Primary Responsibilities:
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Clinical Documentation Review
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Perform expert-level concurrent reviews of inpatient medical records within 24-48 hours
of admission -
Identify documentation gaps, inconsistencies, or insufficient specificity impacting diagnosis capture, Principal diagnosis, SOI/ROM, DRG assignment, and quality metrics
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Clinical Clarification & Query Management
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Initiate and manage compliant queries exclusively through electronic means, to obtain necessary clinical clarification
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Ensure queries are clinically supported, non-leading, and aligned with AHIMA and
organizational query standards -
Conduct daily follow-up on outstanding queries to support timely documentation resolution
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Documentation & System Utilization
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Accurately document all review findings, monitor and resolve queries, responses, and
outcomes using approved CDI tools and platforms (e.g., Midas Clinical Documentation Improvement Focus Study or equivalent systems) -
Maintain clear notes for audit trails to support internal review and external audits
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Education & Continuous Improvement
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Participate in structured physician education initiatives to enhance awareness of
documentation requirements and best practices -
Stay current with evolving documentation, coding, and regulatory guidelines affecting inpatient reimbursement and quality outcomes
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Collaboration & Interdisciplinary Engagement
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Work collaboratively with Medical Coding Professionals to reconcile documentation and
final DRG assignment -
Partner with the Onshore Team who interacts with Physician Advisors, Care coordination and Quality Management teams to identify systemic documentation improvement opportunities
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Support organizational initiatives related to documentation accuracy, compliance, and performance improvement
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Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
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Education: Valid MBBS degree (Indian/FMG credentials)
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Experience: Experience in patient handling and care, critical care or case management is preferred as it provides a foundational understanding of complex patient needs, resource allocation, and the interdisciplinary coordination required in high-acuity healthcare settings
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Technical Skills: Basic understanding of Microsoft Word, Excel, and basic understanding of EMR/EHR
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Standards Knowledge: Basic familiarity with healthcare compliance, clinical documentation, medical terms and concepts, HIPAA, and the general idea of medical coding (ICD-10). Any enhanced knowledge of ICD-10 will be preferential
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Communication Skills: Proven excellent verbal and written skills to effectively articulate document gaps and provide the rationale for clinical queries
Preferred Qualification:
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Certification such as the Certified Clinical Documentation Specialist (CCDS)
Note: There is no face-to-face interaction with physicians due to the offshore nature of the role.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
