RN Clinical Coding Nurse Consultant WellMed San Antonio Texas

3 weeks ago

Floresville, Texas, United States UnitedHealth Group Full time
Job Summary

We are seeking a highly skilled RN Clinical Coding Nurse Consultant to join our team at WellMed, a network of doctors, specialists, and other medical professionals dedicated to providing care for older adults. As a member of our team, you will play a critical role in driving consistent, efficient processes and sharing best practices with providers and market teams 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 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 hire date from the American Academy of Professional Coders
  • 3+ years associated business experience with health care industry
  • 1+ years of ICD-9, ICD10 coding experience
  • Professional experience persuading changes in behavior
  • Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
  • Knowledge base of clinical standards of care and preventative health measures
  • Solid knowledge of the Medicare market, products, and competitors
  • 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
  • MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
  • Proven solid presentation skills and relationship building skills with clinical/non-clinical personnel
  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
  • Demonstrated ability to solve process problems crossing multiple functional areas and business units
  • 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
About UnitedHealth Group

UnitedHealth Group is a leading health care company that is committed to making health care better for everyone. We are a diverse and inclusive organization that values our employees and provides opportunities for growth and development. We are an equal opportunity employer and welcome applications from qualified candidates.

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