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UnitedHealth Group Medicare Consultant - Telecommute in Washington/Oregon in Seattle, Washington

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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This specialist role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're driving ever higher levels of sophistication in how provider networks are composed and compensated. Your expertise in provider networks can help us build in the next phase of evolution. In this managerial role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

If you are located in Washington/Oregon, 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 program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnoses coding. Understand Medicare Stars quality program utilizing analytics and identifies and targeted providers

  • Utilizes analytics and identifies targeted providers for Medicare Risk Adjustment training and documentation/coding resources

  • Assist providers in understanding the MCAIP incentive program, Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology with importance of proper chart documentation of procedures and diagnosis coding

  • Supports the Providers by ensuring documentation requirements are met for the submission of relevant ICD -10 codes and CPTII procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

  • Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes as well as all relevant diagnosis codes are captured

  • Refers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment

  • Provides ICD10 - HCC coding training to providers and appropriate staff (not including CEUs)

  • Consults with Providers and other staff regarding documentation, billing and coding and provides feedback to Providers regarding documentation practices

  • Reviews selected medical documentation to determine appropriate diagnoses, procedures codes and ICD-10 condition are coded per CMS coding guidelines

  • Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding

  • Collaborates with providers, coders, facility staff and a variety of internal and external personnel on wide scope of Risk Adjustment and Quality education efforts

You’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:

  • 1+ years’ experience in Risk Adjustment

  • 1+ years’ experience with HEDIS/Stars

  • 2+ years’ of clinic or hospital experience and/or managed care experience

  • Knowledge of ICD10-CM coding

  • Excellent communication and presentation skills

  • Proficiency in MS Word, Excel (intermediate+), PowerPoint

  • CRC (Certified Risk Adjustment Coder) or CPC (Certified Professional Coder) certification

  • Must live in state of Washington or Oregon, with the ability to travel up to 50%, within those states

  • 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

  • Experience working with coding software and EMR’s

  • Experience performing coding at a healthcare facility

  • Experience working in a provider primary care practice

To 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, 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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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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