8 days old

Field Medicare Coding and Quality Consultant Telecommute in Kentucky - 928436

Louisville, KY 40202 Work Remotely
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  • Job Code
    928436

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doingyour life's bestwork.(sm)

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The Medicare Coding and Quality Consultant is afield-based positionresponsible for providing expertise in the area of quality and risk adjustment coding for provider clients. A Medicare Coding and Quality 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. This person 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. Depending upon client contractual obligations, The Medicare Coding and Quality Consultant will ensure the providers understand the STARS CPTIIcoding requirements. This position will function in a matrix organization taking direction about job function from health plan but reporting directly to Optum.

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Youwill have the flexibility to telecommute* as you take on some tough challenges.

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Primary Responsibilities:

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  • Partners with Healthcare Advocates in the field and will be assigned providers to embed based on data analysis where they need support / training on improving documentation and coding accuracy
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  • Assists providers in understanding the Medicare quality (HEDIS/STARS) program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
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  • Utilizes analytics and identifies and targets providers
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  • Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources
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  • The Medicare Risk Adjustment Coding Consultant will be responsible for facilitating and/or performing an audit of the providers medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately
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  • Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
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  • Supports the providers by ensuring documentation supports the submission ofrelevant ICD-10-CM codes and CPTIIprocedural information in accordance with national coding guidelines and appropriate reimbursement requirements
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  • Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
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  • Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured
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  • Provides thorough, timely and accurate consultation ondocumentation and correctICD-10-CMand/or CPTII code assignmentsby providers
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  • Providescustomized documentation improvement education, including corresponding ICD-10-CM codesto providers and appropriate staff
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  • Develops and presentsdocumenting &coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
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  • Educates oncondition and quality specifictoolsand collateralto providers
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  • Trains physicians and other staff regarding documentationspecificity, codingimpactandquality importance;provides feedback to physicians regarding documentationbestpractice
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  • Educates providers and staff ondocumentation & coding guidelinesand changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations
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  • Performschart note analysis and provides timelyfeedback to providers on a regularly scheduled basis
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  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and codingbestpractices
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  • Reviews selected medical documentation to determine if assigned diagnosisandprocedures codes are appropriately assigned
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  • 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
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This position requires travel up to 75%withinthestate. Relocation is not provided for this position.

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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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  • Certified Professional Coder(CPC)certification
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  • 4+ years of experience with physician billing and/or coding
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  • Experience in Risk Adjustment and/or HEDIS
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  • Proficient in MS Word, Excel, PowerPoint and Outlook
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  • Must be able to work effectively with common office software, coding software, EMR and abstracting systems
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  • Experience managing/maintainingrelationships with physicians/ hospitals/ health systems
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  • Strong communication and presentation skills
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  • Provenrelationship building skills with clinical and non-clinical personnel
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  • Ability to travelwithin stateup to 75%to client locations
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • 4+ years of clinic or hospital and/or managed care experience
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  • Bachelors degree (preferably in Healthcare or relevant field)
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  • Previous experience ina leadershipposition in a physician practice
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  • Registered Nurse
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  • Knowledge of billing/claims submission and other related actions
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  • CPC-I and/or CPMA certificationsfrom AAPC
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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.Sowhen it comes to how we use the worlds 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 carehas togo 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 doyour life's best work.(sm)

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Medicare, Coding, Consultant, Consult, Telecommute, Remote, Work from Home, Kentucky, KY, Louisville, Lexington

Posted: 2021-06-10 Expires: 2021-07-10

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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Field Medicare Coding and Quality Consultant Telecommute in Kentucky - 928436

UnitedHealth Group
Louisville, KY 40202

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