RN Clinical Coding Nurse Consultant WellMed San Antonio Texas Position Available In Ascension, Louisiana

Job Description:

$5000 Sign on Bonus for External Candidates•Opportunities at WellMed, part of the Optum family of businesses.

We believe all patients are entitled to the highest level ofmedical care. Here, you will join a team who shares your passionfor helping people achieve better health. With opportunities forphysicians, clinical staff and non-patient-facing roles, you canmake a difference with us as you discover the meaning behindCaring. Connecting. Growing together.•The Sr. Clinical Coding Nurse Consultant will drive consistent,efficient processes and share best practices in a collaborativeeffort with Providers and Market Team, designed to facilitateachievement of goals set for HCC Ratio, HCC Covered Ratio, and HCCPercent Covered. The Sr. Clinical Coding Nurse Consultant willdrive Risk Adjustment improvement initiatives, developrecommendations for Risk Adjustment remediation plans and createtools and databases to capture relevant data for assigned marketsto achieve corporate and market specific Risk Adjustment goals andinitiatives. This position will work collaboratively with eachregional/market team and their leadership in a matrix relationship•This position will provide direction and guidance to MedicalCoding Analysts, as well as cross functional team members withintheir respective Markets pertaining to Risk Adjustment.•

Primary Responsibilities:

Develop and implement market business plans to motivateproviders to engage in improving Risk Adjustment metrics Provide analytical interpretation of Risk Adjustment reportingincluding, Executive Summaries, HCC Ratio, Disagree and Resolutionrates, and FaxBack reporting to plan and provider groups Subject Matter Expert (SME) for all Risk Adjustment relatedactivities within their assigned market(s) working within a matrixrelationship which includes DataRAP operations and Regional/Marketoperations Assist in developing of training and analytical materials forRisk Adjustment Oversee DataRAP training and education delivery for Mega Groupsvia Provider education sessions and Physician Business Meetings /JOCs Lead Weekly, Monthly, Bi-monthly, Quarterly, and/or AnnualBusiness Review meetings related to Risk Adjustment activitieswhich summarize provider group performance and market performanceas requested by or required by Market leadership Analyze and evaluate provider group structure andcharacteristics, provider group/provider office operations andpersonnel to identify the most effective approaches and strategiesrelated to Risk Adjustment Analyze Provider and Group performance regarding RiskAdjustment and Focus on Care (FOC) to determine areas of focus orimprovement opportunities Develop solution-based, user friendly initiatives to supportpractice success Oversee market specific chart retrieval and review of PCP,Hospital, and Specialist records Work with DataRAP Senior Leadership on identified specialprojects Required in office training 6+ weeks. This position requirestraveling around the San Antonio Texas area including countiessupporting providers’ offices, etc. Mileage Reimbursement will beprovided based on the department guidelines. Certified ProfessionalCoding Certification (CPC) allowance. You’ll be rewarded and recognized for your performance in anenvironment that will challenge you and give you clear direction onwhat it takes to succeed in your role as well as providedevelopment for other roles you may be interested in.

RequiredQualifications:

Bachelor’s degree in Nursing (Associate’s Degree or NursingDiploma from accredited nursing school with 2+ years of additionalexperience may be substituted in lieu of a bachelor’s degree) andcurrent RN license in good standing CPC certification or proof that certification has been obtainedwithin 9 months from hire date from the American Academy ofProfessional Coders 3+ years associated business experience with health careindustry 1+ years of

ICD-9, ICD10

coding experience Professional experience persuading changes in behavior Knowledge of CMS HCC Model and Guidelines along with ICD 10Guidelines Knowledge base of clinical standards of care and preventativehealth measures Solid knowledge of the Medicare market, products andcompetitors Ability and willingness to travel (locally and non-locally) asdetermined by business needs•

Preferred Qualifications:

Undergraduate degree Experience in managed care working with network and providerrelations Additional Medical chart review experience Medical/clinical background MS Office Suite, moderate to advanced EXCEL and PowerPointskills Proven solid presentation skills and relationship buildingskills with clinical/non-clinical personnel Demonstrated ability to interact with medical staff, peers, andinternal company staff at all levels Demonstrated ability to solve process problems crossingmultiple functional areas and business units Proven solid problem-solving skills; the ability to analyzeproblems, draw relevant conclusions and devise and implement anappropriate plan of action Proven good business acumen, especially as it relates toMedicare•The salary range for this role is $71,600 to $140,600 annuallybased on full-time employment. Pay is based on several factorsincluding but not limited to local labor markets, education, workexperience, certifications, etc. UnitedHealth Group complies withall minimum wage laws as applicable. In addition to your salary,UnitedHealth Group offers benefits such as, a comprehensivebenefits package, incentive and recognition programs, equity stockpurchase and 401k contribution (all benefits are subject toeligibility requirements). No matter where or when you begin acareer with UnitedHealth Group, you’ll find a far-reaching choiceof benefits and incentives.•At UnitedHealth Group, our mission is to help people live healthierlives and make the health system work better for everyone. Webelieve everyone-of every race, gender, sexuality, age, locationand income-deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to goodhealth which are disproportionately experienced by people of color,historically marginalized groups and those with lower incomes. Weare committed to mitigating our impact on the environment andenabling and delivering equitable care that addresses healthdisparities and improves health outcomes•an enterprise priorityreflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employerunder applicable law and qualified applicants will receiveconsideration for employment without regard to race, nationalorigin, religion, age, color, sex, sexual orientation, genderidentity, disability, or protected veteran status, or any othercharacteristic protected by local, state, or federal laws, rules,or regulations. UnitedHealth Group is a drug•free workplace. Candidates arerequired to pass a drug test before beginning employment.