WellMed, part of the Optum family of businesses, is seeking a RN Clinical Coding Nurse Consultant to join our team in El Paso, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The Sr. 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. The Sr. Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. This position will provide direction and guidance to Medical Coding Analysts, as well as cross functional team members within their respective Markets pertaining to Risk Adjustment.
Position Highlights & Primary Responsibilities:
- Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics
- Provide analytical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups
- Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional/Market operations
- Assist in developing of training and analytical materials for Risk Adjustment
- Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings / JOCs
- Lead Weekly, Monthly, Bi-monthly, Quarterly, and/or Annual Business Review meetings related to Risk Adjustment activities which summarize provider group performance and market performance as requested by or required by Market leadership
- 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
- Analyze Provider and Group performance regarding Risk Adjustment and Focus on Care (FOC) to determine areas of focus or improvement opportunities
- Develop solution-based, user friendly initiatives to support practice success
- Oversee market specific chart retrieval and review of PCP, Hospital, and Specialist records
- Work with DataRAP Senior Leadership on identified special projects
Required in office training 6+ weeks. This position requires traveling around the El Paso Texas area including counties supporting providers’ offices, etc. Mileage Reimbursement will be provided based on the department guidelines. Certified Professional Coding Certification (CPC) allowance.
Required Qualifications:
- Bachelor’s degree in Nursing (Associate’s Degree or Nursing Diploma from accredited nursing school with 2+ years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing
- CPC certification or proof that certification has been obtained within 9 months from hire date from the American Academy of Professional Coders
- 3+ years associated business experience with health care industry
- 1+ years of ICD-9, ICD10 coding experience
- Professional experience persuading changes in behavior
- Proven knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
- Proven knowledge base of clinical standards of care and preventative health measures
- Proven solid knowledge of the Medicare market, products and competitors
- Access to reliable transportation and the ability and willingness to travel (locally and non-locally) as determined by business needs
Preferred Qualifications:
- Undergraduate degree
- Experience in managed care working with network and provider relations
- Additional Medical chart review experience
- Medical/clinical background
- MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
- Proven solid presentation skills and relationship building skills with clinical/non-clinical personnel
- Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
- Demonstrated ability to solve process problems crossing multiple functional areas and business units
- Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
- Proven good business acumen, especially as it relates to Medicare
Physical & Mental Requirements:
- Ability to push or pull heavy objects using up to pounds of force
- Ability to stand for extended periods of time
- Ability to properly drive and operate a company vehicle
Diversity creates a healthier atmosphere: OptumCare is an 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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