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Regional Coding Educator - Telecommute in TX

Company: UnitedHealth Group
Location: Houston
Posted on: September 24, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Regional Coding Educator (RCE) is responsible for providing expertise in the area of primarily risk adjustment coding for provider clients. The RCE supports the work of the Medicare Consultant (MC) or MC Hybrid in discussing coding for risk adjustment and quality performance reporting. A RCE will interact with operational and clinical leadership to assist in identification of operational and clinical best practices in understanding and assessing chronic condition suspects, appropriate clinical documentation and accurate coding for both risk adjustment and quality reporting. The RCE will facilitate implementation of programs (Medicare Advantage Risk Adjustment and Star Ratings) designed to ensure all diagnoses and CPT II codes are supported by appropriate documentation in the member chart and correct coding according to the AMA, CMS, the CDC and official risk adjustment and quality reporting coding guidelines. The RCE will conduct various targeted chart reviews with provider feedback and provider and staff education to ensure that providers understand appropriate documentation and correct coding that satisfies the requirements of both risk adjustment and quality reporting. This position functions in a matrix organization taking direction about job function from UHC M&R but reporting directly to OptumInsight.

NOTE: Qualified candidates must live in Texas to be considered for this role

If you are located in Texas, you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

  • Assist providers in understanding the CMS-HCC risk adjustment model as it relates to payment methodology and the importance of proper chart documentation and coding of procedures (e.g. Annual Care Visits ACVs and Medical Decision Making) and diagnoses - CPT/HCPCS and ICD-10-CM coding
  • Assist providers in understanding coding for the CMS Medicare Advantage Star Ratings quality program - CPT II coding, the coding for Frailty and Advanced Illness Exclusions and any future coding topics, whenever applicable to a measure
  • Utilize analytics to identify providers with the greatest opportunity for improved reporting, for Medicare Risk Adjustment and Star Ratings
  • Conduct ongoing periodic chart reviews (e.g. quarterly closed suspect chart reviews, Post Visit ACV Reviews PARs , Focused Progress Note Reviews FPNRs ) for appropriate chart documentation and coding, including educating providers on correct coding practices that promote improved healthcare outcomes, utilizing UHC and Optum documentation coding/resources
  • Support providers with individual, group, and multi group documentation coding education sessions, in accordance with federal documentation and coding guidelines, and appropriate UHC requirements, including the provision of UHC and Optum collateral
  • Ensure that member encounter data, including patient name and date of service on every page, are being accurately documented, that method of communication is documented, that services are rendered by the acceptable provider type (e.g. MD, DO, NP, PA, APRNs) and that progress notes are properly authenticated per CMS Risk Adjustment Data Validation Guidelines
  • Provide timely, thorough, and accurate consultation on ICD-10-CM and/or CPT II codes to providers or practice teams (e.g. coders, billers, population health staff)
  • Identify inconsistent or incomplete documentation for coding quality analyst, provider, supervisor or individual department for clarification/additional information or education that leads to accurate code assignment
  • Provide ICD-10-CM and CPT II coding training to providers and appropriate staff (not including CEUs) (Note: MCs who are Approved Trainers can provide CEUs and CMEs)
  • Understand and present to providers Optum and UHC material related to diagnosis coding, quality reporting and UHC incentive programs
  • Train providers and other staff regarding documentation and coding, as well as provide feedback to providers regarding their documentation and coding practices
  • Educate providers and staff on coding regulations and changes as they pertain to risk adjustment and quality reporting to ensure compliance with federal and state regulations
  • Review selected medical record documentation to determine appropriate diagnosis coding and quality reporting coding per CMS, CDC & AMA documentation, and coding guidelines
  • Provide actionable, measurable solutions to providers that will result in improved documentation and coding accuracy, optimal suspect closure, and quality gap closure
  • Collaborate with providers, coders, facility staff and a variety of internal and external personnel on wide scope of risk adjustment and quality reporting education efforts
  • Assist risk adjustment and quality reporting colleagues by providing chart reviews, provider feedback and education
  • Serve as the coding SME to the assigned marketsYou'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
    • Certified Risk Adjustment Coder (CRC) and either Certified Professional Coder (CPC) with AAPC or CCS-P with AHIMA with the requirement to obtain the AAPC Approved Instructor credential within 6 months
    • 5+ years of coding training experience training providers, coders, and billers
    • 4+ years of experience in Risk Adjustment
    • 3+ years of clinic or hospital experience and/or managed care experience
    • Experience in Risk Adjustment and/or HEDIS/Stars Provider education
    • Experience working effectively with common office software, coding software, EMR and abstracting systems
    • Advanced proficiency in MS Office (Excel Pivot tables, excel functions , PowerPoint and Word)
    • Willing to travel at least 25% of the time for onsite training and education as business needs dictate (all travel is within the state of TX, qualified candidates must live in the state of TX)
    • Ability to provide proof of a valid, unrestricted Driver's License and current Auto Insurance
    • Live in the state of TX to qualify for this role
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications:
      • Bachelor's Degree (preferably in Healthcare or relevant field) or equivalent experience
      • Certified Professional Medical Auditor (CPMA) certification
      • 1+ years of coding performed at a health care facility
      • Experience in HEDIS/Stars
      • Experience in management or coding position in a provider primary care practice
      • Knowledge of EMR for recording patient visits
      • Knowledge of billing or claims submission and other related processes Soft Skills:
        • Experience giving group presentations
        • Excellent oral & written communication skills
        • Solid business acumen and analytical skills
        • Good work ethic, desire to succeed, self-starter
        • Ability to deliver training materials designed to improve provider compliance
        • Ability to develop long-term relationships
        • Ability to use independent judgment, and to manage and impart confidential informationTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

          Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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..... click apply for full job details

Keywords: UnitedHealth Group, Houston , Regional Coding Educator - Telecommute in TX, Other , Houston, Texas

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