Senior Consultant, Risk Adjustment & Coding - Telecommuter role in NJ - Full-time / Part-time

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The Senior Consultant, Risk Adjustment and Coding is responsible for providing expertise in the area of clinical coding practices and risk adjustment for provider clients. The role will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates and appropriate coding. The chosen candidate will also coordinate implementation of programs designed to ensure all diagnoses are coded to the highest level of specificity and codes and conditions are properly supported by appropriate documentation in the patient chart.
 
** This is a Telecommuter role will be based in the Newark New Jersey area with travel around the State approximately 75% of the time**
Job duties:


Utilizing data analysis, identify and target providers who would benefit from Medicare Risk Adjustment training and documentation/coding resources.

Facilitate the creation and implementation of measurable improvement strategies in the areas of physician clinical documentation, medical record coding, and submission of data.

Assist providers as related to CMS-HCC Risk Adjustment payment methodology, proper chart documentation, and diagnosis coding to revenue.

Provide ICD10 HCC coding training to providers. Develop and present coding presentations to large and small groups of clinicians, practice managers and certified coders. Training can include custom programs specific to provider's needs.

Provide measurable, actionable solutions to provider that will result in improved accuracy for documentation and coding practices.

Work collaboratively with the CPC Team in development of disease specific training education and tools.

Complete provider visits performing duties described above. Functioning independently, travel within New Jersey to meet with assigned Provider groups to discuss tools and programs focused on improving RAF for Medicare Advantage Members.

Ensure member encounter data is being accurately coded and all diagnosis codes are captured.

Train Providers on our Risk Adjustment tools, and work toward the adoption of these programs into their practices.

Collaborate with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts.

Reach out to physicians, medical groups, IPAs and hospitals, to build positive, long-term, consultative relationships.

Required qualifications:


Certified Professional Coder (CPC) and ICD10 certification

5 or more years of experience in ICD-9 & ICD-10 coding, reimbursement and health information technology including extensive knowledge of and experience with coding concepts, guidelines, and clinical terminology.

Extensive knowledge of what constitutes a complete and accurate record (i.e., complete and thorough clinical documentation beginning with HCC methodology and risk adjustable codes, establishing and meeting medical necessity criteria.)

1 or more years of Provider Relationship experience and/or Network Management, Contracting, Sales or Consulting experience

Knowledge of Managed Care and Medicare programs and guidelines

2 or more years of experience giving presentations

Ability to formulate training materials designed to improve provider compliance

Advanced proficiency in MS Office (Excel, PowerPoint and Word)

Excellent Oral & Written Communication Skills
Preferred Qualifications:


Bachelors or Master’s degree in a healthcare related field

Experience with HEDIS and CMS Stars Ratings

Current and unrestricted RN license
 
 
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.
 
 
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