Registered Nurse RN Senior Clinical Coding Nurse Austin Texas
Company: Optum
Location: Pflugerville
Posted on: March 7, 2025
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Job Description:
Opportunities at WellMed, part of the Optum family of
businesses. We believe all patients are entitled to the highest
level of medical care. Here, you will join a team who shares your
passion for helping people achieve better health. With
opportunities for physicians, clinical staff and non-patient-facing
roles, you can make a difference with us as you discover the
meaning behind Caring. Connecting. Growing together.------ -
The Senior 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. -
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
This is a Office / Field Base position requiring travel in the
Austin area.
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 (associate 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
CPC certification or proof that certification has been obtained
within 9 months from the American Academy of Professional
Coders
5+ years of associated business experience with health care
industry
1+ years of ICD-9, ICD10 coding experience
Knowledge of CMS HCC Model and Guidelines along with ICD 10
Guidelines
Knowledge of the Medicare market, products and competitors
Knowledge base of clinical standards of care and preventative
health measures
Ability and willingness to travel (locally and non - locally) as
determined by business needs
Preferred Qualifications:
Undergraduate degree -
Experience in managed care working with network and provider
relations
Additional Medical chart review experience
Professional experience persuading changes in behavior
Medical / clinical background -
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
Presentation skills and relationship building skills with
clinical/non-clinical personnel
Proven problem solving skills, the ability to analyze problems,
draw relevant conclusions and devise and implement an appropriate
plan of action
Proven good business acumen, especially as it relates to
Medicare
Proven MS Office Suite, moderate to advanced Excel and PowerPoint
skills
Physical & Mental Responsibilities:
Ability to lift up to 10 pounds
Ability to push or pull heavy objects using up to pounds of
force
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate equipment and / or
machinery
Ability to properly drive and operate a company vehicle
Ability to receive and comprehend instructions verbally and/or in
writing
Ability to use logical reasoning for simple and complex problem
solving
The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. 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. -
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. 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. - -
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. -
Keywords: Optum, Pflugerville , Registered Nurse RN Senior Clinical Coding Nurse Austin Texas, Healthcare , Pflugerville, Texas
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