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RN Quality Analyst/Clinical Educator for WellMed in San Antonio, TX

Job Description:


The Quality Analyst Nurse/Clinical Educator performs quality audits to ensure compliance with ICD-9 CM guidelines and CMS Risk Adjustment Data Validation.


Enjoy research and solving problems? Want a balanced life?


No weekends! No Evenings! No On Call!


Work 8am to 5pm Monday to Friday



Essential Job Functions

 

  • Audits work of Clinical Coding Nurses, Medical Coding Analysts, and Processing Coordinator and provides feedback to supervisor/manager.

  • Provides education to include on-boarding and re-education needs.

  • Performs quality audits on providers participating with WellMed Medical Management risk adjustment model.

  • Performs all other related duties as assigned.

  • Ensures compliance with ICD-9 CM guidelines and CMS Risk Adjustment Data Validation requirements.

  • Reports outcomes to the Contracted Physicians Management Department throughout the year.

  • Collaborates with the Chief Education Development Officer / Physician Education Development team, Management Team, Contracted Physicians Management Department, and Provider Relations Team to report educational needs identified or requested.

  • Analyzes data along with Clinical Process Quality Manager to identify deficiencies, measure current state, suggest improvements, implement change, re-measure outcomes, and refine as related to total process.

  • Creates and writes policies in procedures in collaboration with Clinical Process Quality Manager.

  • Communicates with I.T. Department regarding defects in the reporting system or database, tracks through to completion.

  • Monitors Team Discussion Board and answers questions after thorough research.

  • Posts coding updates to the Team Discussion Board for continued education of all current staff as related to coding quality.

  • Creates, maintains, organizes internal and external educational tools as needed as well as updating existing tools with Physician Education Development Team, Contracted Physicians Management Department , and Provider Relations Team.

  • Performs annual HEDIS chart reviews as determined by Clinical Process Quality Manager or contracted plan.

Job Requirements:

  • Current unrestricted RN license in the state of Texas -or- Foreign Medical Graduate

  • CPC certification or willing to obtain within 9 months from the American Academy of Professional Coders.

  • 2+ years of varied clinical experience (preferably in chart review/audits, quality or coding).

  • Knowledge of CMS-HCC model and guidelines

  • Knowledge of ICD-9 CM and guidelines

  • Basic computer and data skills including Access, Excel and Word

  • Ability to interact with multiple departments and outside physician groups

  • Ability to speak and provide presentations and education to small and large groups alike

  • Excellent oral and written communication skills

  • Ability and willingness to travel on occasion as determined by business need


Preferred Education, Experience & Skills


  • Bachelor's degree preferred

  • Strong working knowledge of ICD-9 coding

  • Quality assurance auditing experience


WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services.  Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.


Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness.  We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors.  Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.


WellMed is now part of the OptumHealth division under the greater UnitedHealth Group umbrella.



Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


Key Words: rn, ICD-9; Coding; AAPC; quality nurse, chart review, registered nurse, CPC, san antonio, tx

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Job Category: Nurse
Insurance
Health Care
Job Reference Code: UHG-539027
Position Type: Full-Time
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  • RN Quality Analyst/Clinical Educator for WellMed in San Antonio, TX @ UnitedHealth Group

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