UnitedHealth Group Medicare Consultant – MCAIP – Telecommute within St. Louis, MO area in St. Louis, Missouri

The Medicare Consultant is responsible for providing expertise in the area of quality and risk adjustment coding for provider clients. A Medicare Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding. Medicare Consultant will also coordinate implementation of programs designed to ensure all diagnoses are coded according to CMS and risk adjustment coding guidelines and conditions are properly supported by appropriate documentation in the patient chart. The Medicare Consultant will also ensure that providers understand HEDIS CPTII coding requirements. This position will function in a matrix organization taking direction about job function from UHC M&R but reporting directly to Optum Insight.

If you are in the St. Louis area you’ll enjoy 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

  • Monitor Stars quality performance data for providers and promotes improved healthcare outcomes

  • 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.

  • Routinely consults with medical providers to clarify missing or inadequate record information to determine appropriate diagnostic and procedure codes.

  • 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.

  • Provides thorough, timely and accurate consultation on ICD - 10 and/or CPTII codes to providers or practice teams.

  • 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)

  • Develops and delivers Optum diagnosis coding tools to providers.

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

  • Educates Providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations.

  • Performs analysis and provides formal feedback to Providers on regularly scheduled basis.

  • Provides measurable, actionable solutions to Providers that will result in improved documentation accuracy

  • 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.

Required Qualifications:

  • Bachelor’s degree (preferably in Healthcare or relevant field)

  • 1+ years’ experience in Risk Adjustment and HEDIS / Stars

  • Certified Risk Adjustment Coder or Certified Professional Coder with the American Academy of Professional Coders

  • Minimum 3+ years’ of clinic or hospital experience and/or managed care experience

  • Knowledge of ICD10-CM coding

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

  • Must be able to work effectively with common office software, coding software, EMR and abstracting systems.

Preferred Qualifications:

  • Demonstrate a level of knowledge and understanding of ICD10- CM and CPT coding principles consistent with certification by the American Academy of Professional Coders.

  • Knowledge of EMR for recording patient visits

  • Previous experience in management position in a provider primary care practice

  • Bachelor's degree

  • Minimum of one year of coding performed at a health care facility.

  • Knowledge of billing/claims submission and other related actions

Ideal candidate should possess:

  • Ability to Develop Long Term Relationships

  • Excellent Oral & Written Communication Skills (Experience giving group presentations)

  • Good Work Ethic, Desire to Succeed, Self-Starter

  • Strong business acumen and analytical skills

  • Ability to deliver training materials designed to improve provider compliance

  • Ability to use independent judgment, and to manage and impart confidential information

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing 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.

Job Keywords: ICD-9, ICD-10, CPC, Coder, Trainer, Healthcare, Managed Care, Provider, Medicare, Medicare Risk Adjustment