UnitedHealth Group-posted 9 months ago
$71,600 - $140,600/Yr
Full-time • Senior
Onsite • Tyler, TX
Insurance Carriers and Related Activities

WellMed, part of the Optum family of businesses, is seeking a RN Senior Clinical Coding Nurse Consultant to join our team in Tyler, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

  • 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
  • Bachelor's degree in Nursing (Associate degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor's degree) and current Texas or Compact RN license in good standing
  • Must have a 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
  • Solid knowledge of the Medicare market, products, and competitors
  • Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
  • Knowledge base of clinical standards of care and preventative health measures
  • Proven 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
  • Undergraduate degree
  • Experience in managed care working with network and provider relations
  • Additional Medical chart review experience
  • Medical / clinical background
  • Professional experience persuading changes in behavior
  • MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
  • Proven solid presentation skills and relationship building skills with clinical / non-clinical personnel
  • Proven solid problem-solving skills: the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
  • Proven good business acumen, especially as it relates to Medicare
  • Proven ability to interact with medical staff, peers, and internal company staff at all levels
  • Proven ability to solve process problems crossing multiple functional areas and business units
  • $5,000 Sign-on Bonus for External Candidates
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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