RN Clinical Coding Nurse Consultant WellMed San Antonio Texas

3 weeks ago

San Antonio, Texas, United States UnitedHealth Group Inc Full time
Senior Clinical Coding Nurse Consultant

UnitedHealth Group Inc is seeking a highly skilled Senior Clinical Coding Nurse Consultant to join our team. As a key member of our Risk Adjustment team, you will play a critical 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 which 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
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 associated nursing experience within the health care 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
About UnitedHealth Group Inc

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.

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.

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