RN Clinical Coding Nurse Consultant WellMed San Antonio Texas

1 week ago

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

At UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone. We are seeking a highly skilled Senior Clinical Coding Nurse Consultant to join our team.

Job Summary

The Senior Clinical Coding Nurse Consultant will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. The Senior Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives.

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 their assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional/Market operations
  • Assist in developing of 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 which summarize 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 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
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
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

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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