Full Job Description
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 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 within Ocean County NJ, you will have the flexibility to telecommute* as you take on some tough challenges.
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 coding
Monitors Stars quality performance data for providers and promotes improved healthcare outcomes
Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources
Assist 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 coding
Supports 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 requirements
Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured.
Provides thorough, timely and accurate consultation on ICD-10 and/or CPT 2 codes by providers or practice clinical consultants
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
ProvidesICD10 - HCC coding training to providers and appropriate staff
Develops 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 needs
Develops and delivers diagnosis coding tools to providers
Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians 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 of to providers on a regularly scheduling basis
Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
Reviews selected medical documentation to determine if assigned diagnosis, procedures codes and ICD-10 codes are appropriately assigned
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 doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
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.
Certified Risk Adjustment Coder or Certified Professional Coder with 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 6mos of hire, CPC within 1 year of hire)
3+ years of clinic or hospital experience and / or managed care experience
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 systems
Travel regionally up to 75% (primarily day trips depending on region)
1+ years 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 visits
Previous experience in management position in a physician practice
Coding performed at a health care facility
Knowledge of billing / claims submission and other related actions
Ability to Develop Long Term Relationships
Excellent Oral & Written Communication Skills (Experience giving group presentations)
Good Work Ethic, Desire to Succeed, Self-Starter
Strong business acumen and analytical skills
Ability to formulate training materials designed to improve provider compliance
Ability to use independent judgment, and to manage and impart confidential information
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)
Diversity creates a healthier atmosphere:
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.