RN Clinical Coding Nurse Consultant WellMed San Antonio Texas
3 weeks ago
WellMed, a part of the Optum family of businesses, is seeking a Registered Nurse to join our team in San Antonio, TX. As a clinician-led care organization, we are changing the way clinicians work and live.
About the Role:This is a hybrid/office-based position located near Interstate Highway I-10 West, near West Frontage Road just past The Rim Shopping Center/Ferrari Dealership, 78257. 25% position travel as determined by the business.
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
- 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
- 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 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
- 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
WellMed is a network of doctors, specialists, and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed, our focus is simple: we're innovators in preventative health care, striving to change the face of health care for seniors.
About OptumCare:OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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