Medicare Risk Adjustment Coding Consultant

UnitedHealth Group-posted 9 months ago
$71,600 - $140,600/Yr
Full-time • Manager
Remote • San Diego, CA
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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. You will be in the field consulting with providers approximately 4 days per week and the other 1 day will be working from home. This is a Monday - Friday position. Candidates must reside in San Diego or the surrounding area. This position requires travel up to 75% within the state. Relocation is not provided for this position. If you are located in San Diego, CA, you will have the flexibility to work remotely as you take on some tough challenges.

  • Partners with Healthcare Advocates in the field and will be assigned providers to embed based on data analysis where they need support / training on improving documentation and coding accuracy
  • Utilizes analytics to identify and target providers for Medicare Risk Adjustment training and documentation/coding resources
  • Facilitates and/or performs an audit of the providers' medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately
  • Assists providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
  • Supports the providers by ensuring documentation supports the submission of relevant ICD-10-CM codes in accordance with national coding guidelines and appropriate reimbursement requirements
  • Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
  • Ensures member encounter data (services and disease conditions) is being accurately documented and all relevant diagnosis codes are captured
  • Provides customized documentation improvement education, including corresponding ICD-10-CM codes to providers and appropriate staff
  • Develops and presents documenting & coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
  • Educates providers and staff on documentation & coding guidelines and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations
  • Performs chart note analysis and provides timely feedback to providers on a regularly scheduled basis
  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding best practices
  • Reviews selected medical documentation to determine if assigned diagnosis and procedures codes are appropriately assigned
  • Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
  • Certified Professional Coder (CPC) certification and/or Certified Risk Adjustment Coder
  • 4+ years of experience with physician billing and/or coding
  • Experience in CMS-HCC Risk Adjustment
  • Experience managing/maintaining relationships with physicians/ hospitals/ health systems
  • Ability to work effectively with common office software, coding software, EMR and abstracting systems
  • Proficient in MS Word, Excel, PowerPoint and Outlook
  • Ability to travel within state up to 75% to client locations
  • Reside in San Diego, CA or are willing to relocate to the area without relocation assistance
  • CPC-I and/or CPMA certifications from AAPC
  • 4+ years of clinic or hospital and/or managed care experience
  • Experience in a leadership position in a physician practice
  • Proven knowledge of billing/claims submission and other related actions
  • Proven solid communication and presentation skills
  • Proven relationship building skills with clinical and non-clinical personnel
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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