Clinical Quality Analyst/ Medical Record Reviewer- Rio Grande Valley, TX - Full-time / Part-time

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)

• Review medical record documents and other clinical documentation in provider's charts to identify possible risk adjustment codes


• Evaluate and provide feedback to improve performance of clinic staff with DataMining techniques


• Manage multiple provider office reviews simultaneously and collaborate with supervisor and office administrator to ensure clarity of review and to allow feedback from the provider office


• Track, report, and monitor submissions using quality program forms, processes, and returned request for information, as well as, Data Raps, and progress reports


• Coordinate with supervisor to develop and present reports of medical record reviews to present to physician's office staff


• Progress relationship with Providers office to allow on-site screening if required in order to help physician meet quality program goals and potential need for RAP initiatives in each office


• Analyze errors in submission sent to quality department by physician office and notify supervisor for process improvement plan


• Performs all other related duties as assigned.

• Registered Nurse (RN) or non-licensed medical school graduate


• Familiar with medical review process


• Experience in a clinical setting


• Knowledge of Medical Terminology


• Able to communicate with all levels of the organization


• 3 years' experience working with Medicare/Medicaid


• Flexibility and willingness to shift priorities as often as needed to minimize issues or meet market goals and objectives


• Willing to travel as necessary to complete off-site data mining and screening exam duties


• Knowledgeable in risk adjustment coding


• Knowledgeable in human anatomy and physiology


• Knowledgeable in medications and treatments prescribed in a primary care office


• Basic knowledge of ICD-9 codes


• Three or more years of related healthcare experience


• Strong attention to detail and excellent organizational skills required


• Must have the ability to multi-task in a fast paced and deadline driven environment


• Must be able to maintain professionalism and a positive service attitude at all times


• Ability to effectively report data, facts and recommendations in oral and/or written form


• Ability to analyze facts and exercise sound judgment when arriving at conclusions


• Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook

• 2-5 years of auditing or medical record experience


• Knowledge of Quality Metrics and risk adjustment coding


• Experience with proprietary medical coding systems


• Previous experience in a healthcare environment


• Previous coding experience

• Ability to lift up to 25 pounds


• Ability to sit for extended periods of time


• Ability to use fine motor skills to operate office equipment and/or machinery


• Ability to receive and comprehend instructions verbally and/or in writing


• Ability to use logical reasoning for simple and complex problem solving

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.SM