Senior Clinical Coding Nurse Consultant

7 days ago

Cedar Park, United States UnitedHealth Group Full time

$. Sign on Bonus Available for External Candidates

Incentive Bonus Annually

23 days of PTO & Closed on Major Holidays

 K Match

 This position is located in Austin, Texas and is NOT a Remote position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Sr. Clinical Coding Nurse Consultant will 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. The Sr. Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives. This position will 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.

Primary Responsibilities:

Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metricsProvide analytical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groupsSubject 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 operationsAssist in developing of training and analytical materials for Risk AdjustmentOversee 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 AdjustmentAnalyze 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 successOversee market specific chart retrieval and review of PCP, Hospital, and Specialist recordsWork with DataRAP Senior Leadership on identified special projects

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.

Required Qualifications:

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 standingCPC 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 industry1+ years of ICD-9, ICD10 coding experienceKnowledge of CMS HCC Model and Guidelines along with ICD 10 GuidelinesProfessional experience persuading changes in behaviorSolid knowledge of the Medicare market, products and competitorsKnowledge base of clinical standards of care and preventative health measuresAbility and willingness to travel (locally and non-locally) as determined by business needs.

Preferred Qualifications:

Undergraduate degreeMedical/clinical backgroundExperience in managed care working with network and provider relationsSolid presentation skills and relationship building skills with clinical/non-clinical personnelMS Office Suite, moderate to advanced EXCEL and PowerPoint skillsAdditional Medical chart review experienceDemonstrated ability to interact with medical staff, peers, and internal company staff at all levelsAbility to solve process problems crossing multiple functional areas and business unitsSolid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of actionGood business acumen, especially as it relates to Medicare

Physical & Mental Requirements: 

Ability to lift up to 10 poundsAbility to sit for extended periods of timeAbility to stand for extended periods of timeAbility to use fine motor skills to operate equipment and/or machineryAbility to receive and comprehend instructions verbally and/or in writingAbility to use logical reasoning for simple and complex problem solving

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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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