Senior Clinical Coding Nurse Consultant

5 days ago

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

We are seeking a highly skilled Clinical Coding Nurse Consultant to join our team at UnitedHealth Group. As a key 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.

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 required (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 the American Academy of Professional Coders
  • 5+ years associated business experience with health care industry
  • 1+ years of ICD-9, ICD10 coding experience
  • Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
  • 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
  • Ability and willingness to travel (locally and non-locally) as determined by business needs
Preferred Qualifications
  • Undergraduate degree
  • Medical/clinical background
  • Experience in managed care working with network and provider relations
  • Solid presentation skills and relationship building skills with clinical/non-clinical personnel
  • MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
  • Additional Medical chart review experience
  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
  • Ability to solve process problems crossing multiple functional areas and business units
  • Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action
  • Good business acumen, especially as it relates to Medicare
Physical & Mental Requirements
  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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