RN Senior Clinical Coding Nurse Consultant Athens Tyler Huntsville TX - Clinical
Company: UnitedHealth Group Inc
Location: Athens
Posted on: January 25, 2023
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Job Description:
RN Senior Clinical Coding Nurse Consultant Athens Tyler
Huntsville 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.
This position has openings to cover provider offices in the Athens
, Tyler or Huntsville areas. Hours are Monday - Friday. Mileage
reimbursement provided, Sign-on bonus!
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
project
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 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 Texas or Compact RN license in good standing
* CPC certification or have the ability to obtain a certification
within 9 months of employment from the American Academy of
Professional Coders
* 5+ years of associated business experience within the health care
industry
* 1+ years of ICD-9, ICD10 coding experience
* Knowledge of CMS HCC Model and Guidelines along with ICD 10
Guidelines
* Proven 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
* Reliable transportation that will enable you to travel to client
and / or patient sites within a designated area
* 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
relationsl
* Professional experience persuading changes in behavior
* Additional Medical chart review experience
* Medical / clinical background
* MS Office Suite, moderate to advanced EXCEL and PowerPoint
skills
* Good business acumen, especially as it relates to Medicare
* Ability to solve process problems crossing multiple functional
areas and business units
* Proven problem-solving skills: the ability to analyze problems,
draw relevant conclusions and devise and implement an appropriate
plan of action
* Demonstrated ability to interact with medical staff, peers, and
internal company staff at all levels
* Proven presentation skills and relationship building skills with
clinical / non-clinical personnel
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 realated entity in a full time, part
time, or per diem basis ("Internal candidates") are not eligible to
receive a Sign-On Bonus
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 Inc, Tyler , RN Senior Clinical Coding Nurse Consultant Athens Tyler Huntsville TX - Clinical, Healthcare , Athens, Texas
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