RN Senior Clinical Coding Nurse Consultant San Antonio TX
Company: UnitedHealth Group
Location: San Antonio
Posted on: January 26, 2023
Job Description:
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 lifes 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
projectYoull be rewarded and recognized for your performance in
anenvironment 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.$5,000 Sign on
Bonus for External CandidatesRequired Qualifications:
- Bachelors Degree in Nursing (Associates Degree or Nursing
Diploma from accredited nursing school with 2+ years of additional
experience may be substituted in lieu of a bachelors degree) and
current RN license in good standing
- CPC certification or proof that certification has been obtained
within 9 months from date of hire from the American Academy of
Professional Coders
- 5+ years of associated nursing experience within a health care
industry
- 1+ years of familiarization with ICD10 codes
- Professional experience persuading changes in behavior
- 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
- 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 accommodationPreferred
Qualifications:
- Undergraduate degree
- Experience in managed care working with network and provider
relations
- Medical chart review experience
- Medical / clinical background
- MS Office Suite, moderate to advanced EXCEL and PowerPoint
skills
- 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 MedicareTo
protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies now require all employees to disclose COVID-19
vaccination status prior to beginning employment. In addition, some
roles require full COVID-19 vaccination 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 everyoneof every race, gender, sexuality, age, location and
incomedeserves 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:
UnitedHealth Group is an Equal Employment Opportunity/Affirmative
Action employer 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.UnitedHealth Group is a drug - free
workplace. Candidates are required to pass a drug test before
beginning employment.
Keywords: UnitedHealth Group, San Antonio , RN Senior Clinical Coding Nurse Consultant San Antonio TX, Healthcare , San Antonio, Texas
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