Medicare Risk Adjustment and Coding Consultant - Telecommute - Tallahassee, FL - 2021655

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)

The Medicare Consultant is responsible for providing expertise in the area of quality and risk adjustment coding for provider clients. A Medicare 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. Medicare Consultant 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. The Medicare Consultant will also ensure that providers understand HEDIS CPTII coding requirements. This position will function in a matrix organization taking direction about job function from UHC M&R but reporting directly to Optum Insight. Work is primarily performed at physician practices on a daily basis.

If you are located in Tallahassee, FL, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Assist providers in understanding the CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnoses coding. Understand Medicare Stars quality program utilizing analytics and identifies and targeted providers

Monitor Stars quality performance data for providers and promotes improved healthcare outcomes

Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation / coding resources

Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS – HCC Risk Adjustment driven payment methodology with importance of proper chart documentation of procedures and diagnosis coding

Supports the Providers by ensuring documentation requirements are met for the submission of relevant ICD – 10 codes and CPTII procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

Routinely consults with medical providers to clarify missing or inadequate record information to determine appropriate diagnostic and procedure codes

Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes as well as all relevant diagnosis codes are captured

Provides thorough, timely and accurate consultation on ICD – 10 and/or CPTII codes to providers or practice teams

Refers inconsistent or incomplete patient treatment information / documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment

Provides ICD10 – HCC coding training to providers and appropriate staff (not including CEUs)

Develops and delivers Optum diagnosis coding tools to providers

Trains Providers and other staff regarding documentation, billing and coding and provides feedback to Providers regarding documentation practices

Educates Providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations

Performs analysis and provides formal feedback to Providers on regularly scheduled basis

Provides measurable, actionable solutions to Providers that will result in improved documentation accuracy 

Reviews selected medical documentation to determine appropriate diagnoses, procedures codes and ICD – 10 condition are coded per CMS coding guidelines

Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding

Collaborates with providers, coders, facility staff and a variety of internal and external personnel on wide scope of Risk Adjustment and Quality education efforts

Includes up to 75% local travel

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: 

3+ years of clinic or hospital experience and/or managed care experience

Coding Certification 

Knowledge of ICD10-CM coding

Advanced proficiency with MS Office (Excel, PowerPoint and Word)

Able to work effectively with common office software, coding software, EMR and abstracting systems

Ability to travel 75% locally within the Tallahassee, FL area

Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

Bachelor's degree in Healthcare or relevant field

1+ years of experience with coding performed at a health care facility

1+ years of experience in Risk Adjustment and HEDIS / Stars

Experience in management position in a provider primary care practice

Possess a level of knowledge and understanding of ICD10 – CM and CPT coding principles consistent with certification by the American Academy of Professional Coders

Knowledge of EMR for recording patient visits

Knowledge of billing / claims submission and other related actions

Ability to develop long term relationships

Experience giving group presentations

Ability to deliver training materials designed to improve provider compliance

Ability to use independent judgment, and to manage and impart confidential information

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

Colorado, Connecticut or Nevada Residents Only : The salary/hourly range for Colorado residents is $79,700 to $142,600. The salary/hourly range for Connecticut/Nevada residents is $87,900 to $156,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.