Senior Clinical Coding Nurse Consultant
Join WellMed, a part of the Optum Family! We believe every individual deserves the highest quality of medical care. By joining our team, you'll share in our commitment to helping people achieve better health. Whether you are a physician, clinical staff member, or in a non-patient-facing role, you can make a significant impact with us as we strive for excellence in healthcare.
The Senior Clinical Coding Nurse Consultant position is critical in driving efficient processes and sharing best practices with our Providers and Market Team. Your efforts will focus on achieving set goals for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. This role will lead Risk Adjustment improvement initiatives, develop remediation plans, and create tools to capture vital market-specific data for better health outcomes.
Key Responsibilities:
Develop and implement business plans to inspire providers to enhance Risk Adjustment metrics.
Analyze Risk Adjustment reports, providing insights such as Executive Summaries and HCC ratios.
Act as the Subject Matter Expert (SME) for all Risk Adjustment activities within assigned markets.
Assist in creating training materials to support Risk Adjustment efforts.
Oversee training sessions for DataRAP and provide education to providers.
Lead business review meetings to evaluate provider group and market performance.
Assess provider group operations to determine effective Risk Adjustment strategies.
Analyze performance metrics to identify areas for improvement.
Develop user-friendly initiatives aimed at supporting practice success.
Manage market specific chart retrieval and comprehensive review of medical records.
Collaborate on special projects with DataRAP Senior Leadership.
This is an office/field-based position requiring travel within the Austin area.
At WellMed, you will be rewarded for your performance in a challenging environment that provides clear direction and opportunities for your career development.
Required Qualifications:
Bachelor's degree in Nursing or equivalent experience with a current RN license in good standing.
CPC certification or proof of completion within 9 months from the American Academy of Professional Coders.
5+ years of experience in the healthcare industry.
1+ years of ICD-9, ICD-10 coding experience.
Knowledge of CMS HCC Model & Guidelines and ICD-10 Guidelines.
Familiarity with Medicare markets and related products.
Understanding of clinical standards of care.
Willingness to travel according to business needs.
Preferred Qualifications:
Undergraduate degree in a relevant field.
Experience in managed care focusing on provider relations.
Medical chart review experience.
Ability to drive behavior changes effectively.
Professional clinical background.
Strong interaction skills with medical staff and peers.
Expertise in solving cross-functional process problems.
Excellent presentation and relationship-building skills.
Proven analytical and problem-solving abilities.
Strong business acumen in Medicare.
Advanced skills in MS Office Suite, especially Excel and PowerPoint.
Physical & Mental Responsibilities:
Ability to lift up to 10 pounds.
Ability to push or pull heavy objects with up to pounds of force.
Capacity to sit or stand for extended periods.
Fine motor skills to operate equipment.
Ability to operate a company vehicle safely.
Ability to comprehend instructions clearly.
Logical reasoning skills for problem-solving.
The annual salary for this position ranges from $71,600 to $140,600, reflective of various factors, including local labor markets and experience. WellMed offers a comprehensive benefits package including recognition programs and 401k contributions.
At UnitedHealth Group, our mission is to promote healthier living and improve healthcare for everyone, particularly those facing barriers. We are committed to providing equitable care and addressing health disparities.
We value diversity and are an Equal Employment Opportunity/Affirmative Action employer; all qualified applicants will receive consideration without discrimination.
This is a drug-free workplace. Candidates must pass a drug test before employment.
Apply Now
The Senior Clinical Coding Nurse Consultant position is critical in driving efficient processes and sharing best practices with our Providers and Market Team. Your efforts will focus on achieving set goals for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. This role will lead Risk Adjustment improvement initiatives, develop remediation plans, and create tools to capture vital market-specific data for better health outcomes.
Key Responsibilities:
Develop and implement business plans to inspire providers to enhance Risk Adjustment metrics.
Analyze Risk Adjustment reports, providing insights such as Executive Summaries and HCC ratios.
Act as the Subject Matter Expert (SME) for all Risk Adjustment activities within assigned markets.
Assist in creating training materials to support Risk Adjustment efforts.
Oversee training sessions for DataRAP and provide education to providers.
Lead business review meetings to evaluate provider group and market performance.
Assess provider group operations to determine effective Risk Adjustment strategies.
Analyze performance metrics to identify areas for improvement.
Develop user-friendly initiatives aimed at supporting practice success.
Manage market specific chart retrieval and comprehensive review of medical records.
Collaborate on special projects with DataRAP Senior Leadership.
This is an office/field-based position requiring travel within the Austin area.
At WellMed, you will be rewarded for your performance in a challenging environment that provides clear direction and opportunities for your career development.
Required Qualifications:
Bachelor's degree in Nursing or equivalent experience with a current RN license in good standing.
CPC certification or proof of completion within 9 months from the American Academy of Professional Coders.
5+ years of experience in the healthcare industry.
1+ years of ICD-9, ICD-10 coding experience.
Knowledge of CMS HCC Model & Guidelines and ICD-10 Guidelines.
Familiarity with Medicare markets and related products.
Understanding of clinical standards of care.
Willingness to travel according to business needs.
Preferred Qualifications:
Undergraduate degree in a relevant field.
Experience in managed care focusing on provider relations.
Medical chart review experience.
Ability to drive behavior changes effectively.
Professional clinical background.
Strong interaction skills with medical staff and peers.
Expertise in solving cross-functional process problems.
Excellent presentation and relationship-building skills.
Proven analytical and problem-solving abilities.
Strong business acumen in Medicare.
Advanced skills in MS Office Suite, especially Excel and PowerPoint.
Physical & Mental Responsibilities:
Ability to lift up to 10 pounds.
Ability to push or pull heavy objects with up to pounds of force.
Capacity to sit or stand for extended periods.
Fine motor skills to operate equipment.
Ability to operate a company vehicle safely.
Ability to comprehend instructions clearly.
Logical reasoning skills for problem-solving.
The annual salary for this position ranges from $71,600 to $140,600, reflective of various factors, including local labor markets and experience. WellMed offers a comprehensive benefits package including recognition programs and 401k contributions.
At UnitedHealth Group, our mission is to promote healthier living and improve healthcare for everyone, particularly those facing barriers. We are committed to providing equitable care and addressing health disparities.
We value diversity and are an Equal Employment Opportunity/Affirmative Action employer; all qualified applicants will receive consideration without discrimination.
This is a drug-free workplace. Candidates must pass a drug test before employment.
Apply Now