RN Clinical Coding Nurse Consultant El Paso Texas
5 days ago
WellMed, part of the Optum family of businesses, is seeking a Senior Clinical Coding Nurse Consultant to join our team in El Paso, TX. As a clinician-led care organization, we're changing the way clinicians work and live.
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 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 healthcare industry
- 1+ years of ICD-9, ICD10 coding experience
- Professional experience persuading changes in behavior
- Proven knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
- Proven knowledge base of clinical standards of care and preventative health measures
- Proven solid knowledge of the Medicare market, products, and competitors
- Access to reliable transportation and the ability and willingness to travel (locally and non-locally) as determined by business needs
About WellMed:
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 healthcare, striving to change the face of healthcare for seniors.
Why Join Us:
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
UnitedHealth Group Inc:
UnitedHealth Group Inc is a global health care leader dedicated to helping people live healthier lives and to helping make the health system work better for everyone.
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