Medicare Risk Adjustment and Coding Consultant - Field Based in Newark, NJ
March 9, 2018
Newark, New Jersey
The Medicare Consultant is responsible for providing expertise in the area of quality and risk adjustment coding for assigned provider groups. 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. He/she 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 the providers understand the STARS CPTII coding requirements. This position will function in a matrix organization taking direction about job function from UHC and M&R but reporting directly to Optum Insight. If you are located in the Newark, NJ area you will have the flexibility to telecommute as you take on some tough challenges. Primary Responsibilities: Assists providers in understanding the CMS-HC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis codingMonitors Stars quality performance data for providers and promotes improved healthcare outcomesUtilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resourcesAssist providers in understanding the Medical Condition Assessment Incentive Program and Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis codingSupports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPTII procedural information in accordance with national coding guidelines and appropriate reimbursement requirementsRoutinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codesEnsures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are capturedProvides thorough, timely and accurate consultation on ICD-10 and/or CPT 2 codes by providers or practice clinical consultantsRefers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignmentProvides ICD10 - HCC coding training to providers and appropriate staffDevelops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needsDevelops and delivers diagnosis coding tools to providersTrains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practicesEducates providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulationsPerforms analysis and provides formal feedback to providers on a regularly scheduled basisProvides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practicesReviews selected medical documentation to determine if assigned diagnosis, procedures codes and ICD-10 codes are appropriately assignedAssesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate codingCollaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
Required Qualifications: 3+ years of clinic or hospital experience and/or managed care experienceCertified Risk Adjustment Coder or Certified Professional Coder with American Health Information Management Association or American Academy of Professional Coders with willingness to obtain required certification within first year in position - CRC or CPC whichever is not credentialed at time of hire. (CRC within 6 month of hire, CPC within 1 year of hire)Knowledge of ICD10 Intermediate level of proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)Must be able to work effectively with common office software, coding software, EMR and abstracting systemsAbility to travel regionally up to 75% (primarily day trips depending on region)Preferred Qualifications: 1+ years of experience in Risk Adjustment and HEDIS/Stars Bachelor's degree (preferably in Healthcare or relevant field) Demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders. Knowledge of EMR for recording patient visitsPrevious experience in management position in a physician practice1+ year of experience coding in health care facilityKnowledge of billing/claims submission and other related actions Soft Skills: Ability to develop long-term relationshipsExcellent oral & written communication skills (experience giving group presentations)Good work ethic, desire to success, self-starterStrong business acumen and analytical skillsAbility to formulate training materials designed to improve provider complianceAbility to use independent judgment, and to manage and impart confidential informationBuilding diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm) 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.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords:ICD-9, ICD-10, CPC, Coder, Trainer, Healthcare, Managed Care, Provider, Medicare, Medicare Risk Adjustment. LPN, RN, Newark, NJ, New Jersey
Internal Number: 749259
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.