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  • Little Rock, AR

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Medicare Risk Adjustment and Coding Consultant - Field Based in Little Rock, AR

UnitedHealth Group • Little Rock, AR

Posted 3 days ago

Job Snapshot

Healthcare - Health Services
Health Care


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Job Description

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This specialist role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're driving ever higher levels of sophistication in how provider networks are composed and compensated. Your expertise in provider networks can help us build in the next phase of evolution. In this managerial role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader. Building diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)

The Medicare Consultant is responsible for providing expertise in the area of quality and risk adjustment coding for assigned provider groups. A Medicare Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding.  He/she will also coordinate implementation of programs designed to ensure all diagnoses are coded according to CMS and risk adjustment coding guidelines and conditions are properly supported by appropriate documentation in the patient chart.  The Medicare Consultant will also ensure the providers understand the STARS CPTII coding requirements.  This position will function in a matrix organization taking direction about job function from UHC and M&R but reporting directly to Optum Insight.

If you are located in the Little Rock, AZ area, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Assists providers in understanding the CMS-HC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

  • Monitors Stars quality performance data for providers and promotes improved healthcare outcomes

  • Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation / coding resources

  • Assist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

  • Supports the providers by ensuring documentation supports the submission of relevant ICD - 10 codes and CPTII procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

  • Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes

  • Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured

  • Provides thorough, timely and accurate consultation on ICD-10 and / or CPT 2 codes by providers or practice clinical consultants

  • Refers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment

  • Provides ICD10 - HCC coding training to providers and appropriate staff

  • Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs

  • Develops and delivers diagnosis coding tools to providers

  • Trains physicians and other staff regarding documentation, billing and coding and  provides feedback to physicians regarding documentation practices

  • Educates providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations

  • Performs analysis and provides formal feedback to providers on a regularly scheduled basis

  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

  • Reviews selected medical documentation to determine if assigned diagnosis, procedures codes and ICD-10 codes are appropriately assigned

  • Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding

  • Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts

Required Qualifications:

  • 3+ years of clinic or hospital experience and/or managed care experience

  • Certified Risk Adjustment Coder or Certified Professional Coder with American Health Information Management Association or American Academy of Professional Coders with willingness to obtain required certification within first year in position - CRC or CPC whichever is not credentialed at time of hire.  (CRC within 6 month of hire, CPC within 1 year of hire)

  • Knowledge of ICD10

  • Intermediate level of proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)

  • Must be able to work effectively with common office software, coding software, EMR and abstracting systems

  • Ability to travel regionally up to 75% (primarily day trips depending on region)

Ideal candidate should possess:

  • Ability to develop long-term relationships

  • Excellent oral & written communication skills (experience giving group presentations)

  • Good work ethic, desire to success, self-starter

  • Strong business acumen and analytical skills

  • Ability to formulate training materials designed to improve provider compliance

  • Ability to use independent judgment, and to manage and impart confidential information

  Preferred Qualifications: 

  • 1+ years of experience in Risk Adjustment and HEDIS / Stars 

  • Bachelor’s degree (preferably in Healthcare or relevant field)

  • Demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders

  • Knowledge of EMR for recording patient visits

  • Previous experience in management position in a physician practice

  • 1+ year of experience coding in health care facility

  • Knowledge of billing/claims submission and other related actions

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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:  ICD-9, ICD-10, CPC, Coder, Trainer, Healthcare, Managed Care, Provider, Medicare, Medicare Risk Adjustment. LPN, RN

Job ID: 2551_752038
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