Clinical Documentation Integrity & Utilization Review Specialist

Avera Health

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$29.25 - $44.00

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Provides vital administrative and operational support to ensure the efficiency and effectiveness of CDI and UR programs. This role is instrumental in maintaining seamless daily workflows by coordinating documentation processes, managing denial tracking, and supporting clinical teams with non-clinical tasks. By handling essential administrative responsibilities, the Specialist enables clinical staff to concentrate on work requiring clinical decision-making.

What you will do

• Coordinates daily administrative tasks to facilitate collection, organization and distribution of clinical documentation to support CDI/UR workflows.
• Clinical Denial Management support: tracks, monitors, coordinates and assists with routing of clinical denials to internal stakeholders as well as external payers/auditors.
• Communication liaison for the clinical teams related to exchange and issue resolution as well as communicating non-clinical functions to the payers to assist with compliance to payer policies.
• Assists as the primary liaison to management for identifying, documentation and escalating workflow inefficiencies or opportunities for improvement.
• Proactively monitors operations to determine patters or issues that require further collaboration to enhance overall program performance.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• 3-5 years working in healthcare or in a health system
• Familiarity with medical terminology and healthcare documentation

Preferred Education, License/Certification, or Work Experience:

• Associate's
• Bachelor's

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.