Medical Records Reviewer, Healthcare / Clinical Quality Analyst, WellMed, 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)
 
Registered Nurses! We're excited to announce a Meet and Greet taking place on Tuesday, September 8th at the DFW Airport Marriot in Dallas from 4-8pm Central. At this event you will learn more about why thousands of RN's have made Optum, a part of UnitedHealth Group's family of businesses, their employer of choice. Interested in learning more? Register here:  http://uhg.hr/1TTkSr5.
 
The Medical Record Reviewer is expected to work directly with Physicians and Midlevel Providers to proactively review medical records and other clinical documentation to identify possible risk adjustment codes.  The Major focus of the Medical Record Reviewer will be to collect and review documents to support physician's healthcare management and the company's quality and risk adjustment initiatives.
 
 
Must be Authorized to work in the U.S. 80 % Travel to various medical office as indicated by WellMed
 
 
Essential Job Functions

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.

Minimum Required Education, Experience & Skills

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
 
 
Preferred Education, Experience & Skills

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
 
 
Physical & Mental Requirements:

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
 
Diversity creates a healthier atmosphere: 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: Clinical Quality Analyst, Medical Record Reviewer, Registered Nurse, Non-License Medical School Graduate, Analyze, Risk Adjustment, Monitor, Medical Terminology, Medicare, Medicaid, ICD-9, Quality Metrics, Human Anatomy, Physiology, Rio Grande City, TX