RN Clinical Coding Nurse Consultant El Paso Texas

4 days ago


Anthony, Texas, United States Optum Full time
Job Title: RN Clinical Coding Nurse Consultant El Paso Texas

Optum is seeking a RN Clinical Coding Nurse Consultant to join our team in El Paso, TX. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

As a Clinical Coding Nurse Consultant, you'll 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.

You'll work collaboratively with each regional/market team and their leadership in a matrix relationship. This position will provide direction and guidance to Medical Coding Analysts, as well as cross functional team members within their respective Markets pertaining to Risk Adjustment.

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 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
  • 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


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