RN Clinical Coding Nurse Consultant WellMed San Antonio Texas

21 hours ago

Le Chesnay, Île-de-France, United States Optum Full time
Senior Clinical Coding Nurse Consultant Opportunity

WellMed, a leading healthcare organization, is seeking a highly skilled Senior Clinical Coding Nurse Consultant to join our team in San Antonio, Texas. As a key member of our Optum Care Delivery team, you will play a vital role in driving consistent, efficient processes and sharing best practices with Providers and Market Teams.

Key Responsibilities:
  • Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics
  • Provide analytical interpretation of Risk Adjustment reporting, including Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups
  • Subject Matter Expert (SME) for all Risk Adjustment related activities within assigned markets, working within a matrix relationship that includes DataRAP operations and Regional/Market operations
  • Assist in developing training and analytical materials for Risk Adjustment
  • Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings/JOCs
  • Lead Weekly, Monthly, Bi-monthly, Quarterly, and/or Annual Business Review meetings related to Risk Adjustment activities, summarizing provider group performance and market performance as requested by or required by Market leadership
  • Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies related to Risk Adjustment
  • Analyze Provider and Group performance regarding Risk Adjustment and Focus on Care (FOC) to determine areas of focus or improvement opportunities
  • Develop solution-based, user-friendly initiatives to support practice success
  • Oversee market-specific chart retrieval and review of PCP, Hospital, and Specialist records
  • Work with DataRAP Senior Leadership on identified special projects
Requirements:
  • Bachelor's degree in Nursing (Associate's degree or Nursing Diploma from accredited nursing school with 2+ years of additional experience may be substituted in lieu of a bachelor's degree) and current RN license in good standing
  • CPC certification or proof that certification has been obtained within 9 months from date of hire from the American Academy of Professional Coders
  • 5+ years of associated nursing experience within the healthcare industry
  • 1+ years of familiarization with ICD10 codes
  • Professional experience persuading changes in behavior
  • Solid knowledge of the Medicare market, products, and competitors
  • Knowledge base of clinical standards of care and preventative health measures
  • Proven ability and willingness to travel (locally and non-locally) as determined by business needs
Preferred Qualifications:
  • Undergraduate degree
  • Experience in managed care working with network and provider relations
  • Additional Medical chart review experience
  • Medical/clinical background
  • Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
  • Proven ability to solve process problems crossing multiple functional areas and business units
  • Proven solid presentation skills and relationship building skills with clinical/non-clinical personnel
  • Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action
  • Proven good business acumen, especially as it relates to Medicare
  • Proven MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
Physical & Mental Requirements:
  • Ability to push or pull heavy objects using pounds of force
  • Ability to stand for extended periods of time
  • Ability to properly drive and operate a company vehicle

At Optum, we are committed to creating a healthier atmosphere by embracing diversity and promoting inclusion. We are an Equal Employment Opportunity/Affirmative Action employer and welcome applications from qualified candidates 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.

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

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