Medical Coding Advisor CPC

Company: UnitedHealth Group Inc.
Location: Mcallen
Posted on: June 10, 2021

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 life's best work.(sm)

The Medical Coding Advisor serves as the subject matter expert for coding questions related to attestations and progress notes as well as the submission process for all PCPs, processors, PBMs and other network staff in all markets as well as serving as the acting Manager in the Manager's absence. Responsible for validating progress notes and entering the appropriate ICD-10 coding into the DataRAP database utilizing the Centers for Medicare and Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) guidelines. The position is also responsible for the timely communication of identified quality issues concerning documentation and validation pertaining to the CMS-HCC methodology and ICD-10-CM coding guidelines back to the provider.

Primary Responsibilities:

• Facilitates education sessions for Primary Care Physicians, Physician Business Managers,
• and Network coordinators including but not limited to RAPS University
• Uploads and maintain "frequently asked questions" on the company SharePoint site
• Analyzes progress notes and documentation sent by providers for validation following CMS guidelines and ICD-10 Coding Manual guidelines and enters final results into appropriate tab of the DataRAP database
• Performs validations consistent with established departmental goals
• Provides clear communication, with use of DataRAP application, through query to PCP on documentation not meeting standard as identified by "no plan"
• Ensures accuracy of entry by comparing to outcome of diagnoses on eAttestation post validations entry
• Provides coding support to the DataRAP Clinical Coding nurses, medical coding analysts and to the providers participating in the DataRAP process
• Identifies and reports quality concerns and errors
• Provides relevant updates utilizing all resource subscriptions

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:

• High School diploma or GED equivalent
• CPC certification or ability to obtain one within nine months from the American Academy of Professional Coders
• 5+ years of coding experience
• Experience working directly with providers particularly in training on coding
• Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook
• Knowledge of ICD-10 CM guidelines and coding
• Some traveling may be required
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
• You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
• Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

• 6+ years of coding experience.
• 1+ years serving in a lead capacity
• Able to maintain professionalism and a positive service attitude at all times
• Strong attention to detail
• Ability to perform in a deadline driven environment
• Good communication, writing, and presentation skills
• Ability to effectively report deficiencies with a recommended solution in oral and/or written form
• Ability to analyze facts and exercise sound judgment when arriving at conclusions

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)

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.

Job Keywords: Medical Coding Advisor, McAllen, TX, Texas

Keywords: UnitedHealth Group Inc., McAllen , Medical Coding Advisor CPC, Other , Mcallen, Texas