Risk Adjustment Clinical Documentation Improvement Specialist - Horsham, PA, Eastern PA or Delaware

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

This role will provide coding quality auditing services and evaluates clinical documentation to ensure accurate coding.  This position is also responsible for timely communication of identified quality issues concerning documentation and coding. The ultimate goal is improvement in coding accuracy across the Care Delivery.  The minimum productivity goal is set by project with an expectation of minimum 95% accuracy rate.

Primary Responsibilities:

Required Qualifications:

• HS Diploma or higher or significant equivalent work experience
• Coding Certification required (CPC, CCS, CCS-P, or RHIT;  CPC - A or CCA designation is not acceptable)
• 4+ years’ experience ICD - 9 / 10 coding, preferably in a Managed Care setting, with strong attention to detail and high accuracy rate
• 2+ years’ coding experience in a provider’s office, inpatient setting or a Medicare Advantage health plan setting – can be combined experience
• 2+ years’ Medicare Risk Adjustment experience
• 2+ years’ Provider education experience – communicating directly with providers
• Compliant Physician query experience/knowledge
• 1+ year experience in a coding auditor role
• Proficient knowledge of CMS - HCC model and guidelines
• ICD - 10 - CM proficient
• Knowledge of HEDIS / STARS
• Normal schedule M - F 8am - 5pm, ability to work a flexible schedule to meet business needs and accommodate meetings in various time zones as needed
• Ability to work across a matrix environment
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
• Up to 75% travel (local, non - local meetings)
• Must be able to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations

Preferred Qualifications:

• Bachelor’s degree
• CRC (Certified Risk Coder) in addition to required coding certification
• ICD - 10 - CM trainer
• 1+ years HEDIS / STARS experience
• Previous experience with WebEx or similar virtual meeting tools
• Previous experience with data analysis and reporting
• Previous experience using diagnosis coding data and trends to identify training opportunities
  

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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: 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: Pittsburgh, PA, Horsham, Pennsylvania, risk, adjustment, documentation, improvement specialist, coding, audit, medicare, CMS, HEDIS, Optum, risk adjustment