RN Senior Clinical Coding Consultant - Dallas, TX - Clinical
Company: UnitedHealth Group
Location: Dallas
Posted on: January 27, 2023
Job Description:
RN Senior Clinical Coding Consultant - Dallas, TX$5,000 Sign-on
Bonus for external candidates Do you have compassion and a passion
to help others? Transforming healthcare and millions of lives as a
result starts with the values you embrace and the passion you bring
to achieve your life's best work.(sm) 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 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 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 (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
- Current unrestricted Texas RN license or Compat State
License
- CPC certification or proof that certification has been obtained
within 9 months from the American Academy of Professional
Coders
- 5+ years of associated business experience with health care
industry
- 1+ years of ICD-9, ICD10 coding experience
- Professional experience persuading changes in behavior
- Knowledge of CMS HCC Model and Guidelines along with ICD 10
guidelines
- 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
- This position requires Tuberculosis screening as well as proof
of immunity to Measles, Mumps, Rubella, Varicella, Tetanus,
Diphtheria, and Pertussis through lab confirmation of immunity,
documented evidence of vaccination, or a doctor's diagnosis of
disease
- Full COVID-19 vaccination is an essential job function of this
role. Candidates located in states that mandate COVID-19 booster
doses must also comply with those state requirements. UnitedHealth
Group will adhere to all federal, state and local regulations as
well as all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance. Candidates must be able to perform all essential
job functions with or without reasonable accommodation Preferred
Qualifications:
- Undergraduate degree
- Experience in managed care working with network and provider
relations
- Additional Medical chart review experience
- Medical/clinical background
- Moderate to advanced skills with MS Office suite, including
Excel and PowerPoint
- Solid presentation skills and relationship building skills with
clinical / non-clinical personnel
- 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
- Providers in the area of Irving, McKinney and Rockwall To
protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment Careers with WellMed.
Our focus is simple. We're innovators in preventative health care,
striving to change the face of health care for seniors. We're
impacting 550,000+ lives, primarily Medicare eligible seniors in
Texas and Florida, through primary and multi-specialty clinics, and
contracted medical management services. We've joined Optum, part of
the UnitedHealth Group family of companies, and our mission is to
help the sick become well and to help patients understand and
control their health in a lifelong effort at wellness. Our
providers and staff are selected for their dedication and focus on
preventative, proactive care. For you, that means one incredible
team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led
company that could change the face of healthcare delivery for
seniors. Through the WellMed Care Model, we specialize in helping
our patients stay healthy by providing the care they need from
doctors who care about them. We partner with multiple Medicare
Advantage health plans in Texas and Florida and look forward to
continuing growth. **PLEASE NOTE** The Sign On Bonus is only
available to external candidates. --Candidates who are currently
working for a UnitedHealth Group, UnitedHealthcare or a related
entity in a full time, part time, or per diem basis ("Internal
Candidates") are not eligible to receive a Sign-On Bonus. 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.
Keywords: UnitedHealth Group, Dallas , RN Senior Clinical Coding Consultant - Dallas, TX - Clinical, Healthcare , Dallas, Texas
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