RN Senior Coding Nurse Athens or Huntsville TX - Athens, TX - OR - Operating Room
Company: UnitedHealth Group
Location: Athens
Posted on: March 17, 2023
Job Description:
RN Senior Coding Nurse Athens or Huntsville TX - Athens,
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 2 openings to cover provider offices
in the Athens -Gun Barrel City, TX areas or Huntsville -Crockett TX
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
- East Dallas -- 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, Tyler , RN Senior Coding Nurse Athens or Huntsville TX - Athens, TX - OR - Operating Room, Healthcare , Athens, Texas
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