Senior Clinical Coding Nurse Consultant
1 week ago
We are seeking a highly skilled Senior Clinical Coding Nurse Consultant to join our team at UnitedHealth Group Inc. in Jacksonville, FL.
This is a unique opportunity to work with a clinician-led care organization that is changing the way clinicians work and live.
As a member of our team, you will be an integral part of our vision to make healthcare better for everyone.
You will have the clinical resources, data, and support of a global organization behind you, empowering you to help your patients live healthier lives.
Key Responsibilities- Develop and Implement Market Business Plans
Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics.
Provide Analytical Interpretation of Risk Adjustment ReportingProvide 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 for Risk Adjustment ActivitiesSubject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s), working within a matrix relationship which includes DataRAP operations and Regional/Market operations.
Develop Training and Analytical MaterialsAssist in developing of training and analytical materials for Risk Adjustment.
Oversee DataRAP Training and EducationOversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings/JOCs.
Lead Business Review MeetingsLead 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 Provider Group Structure and CharacteristicsAnalyze 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 PerformanceAnalyze Provider and Group performance regarding Risk Adjustment and Focus on Care (FOC) to determine areas of focus or improvement opportunities.
Develop Solution-Based InitiativesDevelop solution-based, user-friendly initiatives to support practice success.
Oversee Market-Specific Chart Retrieval and ReviewOversee market-specific chart retrieval and review of PCP, Hospital, and Specialist records.
Work on Special ProjectsWork with DataRAP Senior Leadership on identified special projects.
Requirements- Bachelor's Degree in Nursing
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 CertificationCPC 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 Experience5+ years associated nursing experience within the health care industry.
1+ Years of Familiarization with ICD10 Codes1+ years of familiarization with ICD10 codes.
Professional Experience Persuading Changes in BehaviorProfessional experience persuading changes in behavior.
Proven Knowledge of the Medicare MarketProven solid knowledge of the Medicare market, products, and competitors.
Demonstrated Knowledge Base of Clinical Standards of CareDemonstrated knowledge base of clinical standards of care and preventative health measures.
Ability and Willingness to TravelAbility and willingness to travel (locally and non-locally) as determined by business needs.
Preferred Qualifications- Undergraduate Degree
Undergraduate degree.
Experience in Managed CareExperience in managed care working with network and provider relations.
Knowledge of CMS HCC Model and GuidelinesKnowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines.
Solid Presentation SkillsSolid presentation skills and relationship building skills with clinical/non-clinical personnel.
Demonstrated Ability to Interact with Medical StaffDemonstrated ability to interact with medical staff, peers, and internal company staff at all levels.
Ability to Solve Process ProblemsAbility to solve process problems crossing multiple functional areas and business units.
Solid Problem-Solving SkillsSolid problem-solving skills; the ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action.
Good Business AcumenGood business acumen, especially as it relates to Medicare.
Medical/Clinical BackgroundMedical/clinical background highly desirable.
MS Office Suite SkillsMS Office Suite, moderate to advanced EXCEL and PowerPoint skills.
Additional Medical Chart Review ExperienceAdditional Medical chart review experience.
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