Sr. Clinical Coding Nurse Consultant - Telecommute 2386168 | Orlando, Florida | WellMed

Sr. Clinical Coding Nurse Consultant

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind 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.

If you live in the state of Florida, this position is a Hybrid role.

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

You'll 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.

Required Qualifications:

• Bachelor's Degree in Nursing required (Associate's Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor's degree) and current RN license in good standing required
• CPC certification or proof that certification has been obtained within 9 months from date of hire from the American Academy of Professional Coders required
• 5+ years associated nursing experience within health care industry
• 1+ years of familiarization with ICD10 codes
• Professional experience persuading changes in behavior
• Solid knowledge of the Medicare market, products and competitors
• Knowledge base of clinical standards of care and preventative health measures
• Proven ability and willingness to travel (locally and non-locally) as determined by business needs
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease

Preferred Qualifications:

• Undergraduate degree preferred
• Additional Medical chart review experience
• Experience in managed care working with network and provider relations
• Medical/clinical background highly desirable
• Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
• MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
• Good business acumen, especially as it relates to Medicare
• 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
• Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

Physical & Mental Requirements :

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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