1+ months

Clinical Coding Nurse Consultant - 940673

Orlando, FL 32801
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  • Job Code
    940673

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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The Clinical Nurse Coding Consultant, II reports to the Manager, Clinical Data Operations, Risk Adjustment. This role works with Medical Directors and Operations on projects that impact operational and clinical excellence. The 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.

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Primary Responsibilities:

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  • Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
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  • Represents the Company in a professional manner, following all Company policies and procedures
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  • Demonstrates the Companys core values
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  • Provide analytical interpretation of Risk Adjustment reporting including, HCC Ratio, HCC Covered Ratio, and HCC Percent Covered, and FaxBack reporting to plan and provider groups
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  • Reviews medical charts (through multiple EHR systems) for clinical opportunities.
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  • Abstracts clinical and non-clinical information
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  • Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market
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  • Prepares audit reports
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  • Review and provide feedback on the development of training and analytical materials for Risk Adjustment
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  • Participate and prepare for Center Business Reviews
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  • 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
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  • Analyze Provider and Group performance regarding Risk Adjustment to determine areas of focus or improvement opportunities
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  • Performs additional duties as assigned
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  • Consistent, punctual and reliable attendance
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  • Travel may be required
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Youll 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.

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Required Qualifications:

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  • Bachelors Degree in Nursing (Associates Degree or Nursing Diploma from accredited nursing school for a RN with 2+ years of additional experience or LPN with 4+ years of additional experience may be substituted in lieu of a bachelors degree) and current RN/LPN license in good standing
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  • CRC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders
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  • 4+ years of associated business experience with health care industry
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  • 2+ years of ICD 10 coding experience
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  • Professional experience persuading changes in behavior
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  • Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
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  • Sound knowledge of the Medicare market, products and competitors
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  • Knowledge base of clinical standards of care and preventative health measures
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  • Ability to solve process problems crossing multiple functional areas and business units
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  • Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
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  • Excellent clinical skills. Clinical knowledge of chronic medical conditions
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  • Excellent data collection and analytical skills with ability to perform basic data analysis
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  • Computer literate. Proficient with Microsoft Products; Excel, PowerPoint, Word and Outlook
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  • Ability to use multiple EMR systems and traditional paper charts
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  • Good business acumen, especially as it relates to Medicare
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  • Achieve and maintain a yearly 95% inter-rater reliability review score
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  • Ability to implement review guideline changes quickly and accurately
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  • Ability to sit and use a computer for an extended period of time
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  • Ability to read, write, speak, and understand the English language fluently
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  • Ability and willingness to travel (locally and non-locally) as determined by business needs
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  • You will be asked to perform this role in an office setting or other company location
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  • 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
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  • Preferred Qualifications:
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  • Undergraduate degree
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  • Solid presentation skills and relationship building skills with clinical/non-clinical personnel
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  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
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  • Medical/clinical background
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  • MS Office Suite, moderate to advanced Excel and PowerPoint skills
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  • Excellent communication skills (written and spoken)
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  • Able to work independently as well as with cross-functional teams
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  • Proficient prioritizing, handling multiple projects and achieving goals on time
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  • Flexible and able to shift priorities rapidly depending upon the needs of the organization
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  • Ability to manage significant workload, to work professionally and efficiently under pressure meeting established deadlines with minimal supervision
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  • Exudes confidence and speaks with self-assurance
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If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.

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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)

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Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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.

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Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Clinical Coding Nurse Consultant, Clinical Coding, Coding, Medical Coding, Consultant, CRC, Certified Risk Adjustment Coder, Nurse, Risk Adjustment, Saint Petersburg, St. Petersburg, FL, Florida, LDMG, LDMG FL

Posted: 2021-06-26 Expires: 2021-07-30

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Clinical Coding Nurse Consultant - 940673

UnitedHealth Group
Orlando, FL 32801

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