Sr. Clinical Coding Nurse RN Consultant McAllen RGV Texas - Mcallen, TX - Clinical
Company: UnitedHealth Group
Location: Mcallen
Posted on: August 7, 2022
Job Description:
Sr. Clinical Coding Nurse RN Consultant McAllen RGV Texas -
Mcallen, TXDo 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.--
There is a $1,000 employee referral bonus for external candidate
referrals.----This position will require travel to WellMed clinics
meeting with providers.-- 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
projects 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 RN license in good standing
- CPC certification or proof that certification has been obtained
within 9 months from the American Academy of Professional
Coders
- 5+ years of associated business experience with health care
industry
- 1+ years of ICD-9, ICD10 coding experience
- Knowledge of CMS HCC Model and Guidelines along with ICD 10
Guidelines
- Professional experience persuading changes in behavior
- Strong 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 requirement 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 Preferred Qualifications:
- Experience in managed care working with network and provider
relations
- Strong 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
- Strong 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 Medicare
- Medical / clinical background highly desirable
- Undergraduate degree preferred
- MS Office Suite, moderate to advanced Excel and PowerPoint
skills
- Additional Medical chart review experience Physical and Mental
Requirements:--
- Ability to lift up to 10 pounds
- Ability to push or pull heavy objects using up to pounds of
force
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate equipment and / or
machinery
- Ability to properly drive and operate a company vehicle
- Ability to receive and comprehend instructions verbally and /
or in writing
- Ability to use logical reasoning for simple and complex problem
solving 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) **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. --
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, McAllen , Sr. Clinical Coding Nurse RN Consultant McAllen RGV Texas - Mcallen, TX - Clinical, Professions , Mcallen, Texas
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