Medicare Consultant - Field Based - Telecommute in Athens, GA - 2032504
πριν από 22 ώρες

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 or ACVs) and diagnoses

  • 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
  • Monitor appropriate chart documentation and consult with providers on correct coding practices that promotes improved healthcare outcomes
  • Utilize analytics to identify providers with the greatest opportunity for improved reporting, for Medicare Risk Adjustment and documentation and coding training utilizing UHC and Optum documentation / coding resources
  • Assist providers in understanding the MCAIP incentive program, the CMS-HCC risk adjustment model and payment methodology, and the CMS Medicare Advantage Star Ratings program and the importance of proper chart documentation and coding of certain procedures (e.
  • g. ACVs), diagnoses and quality reporting codes

  • Support providers by ensuring documentation requirements are met for the submission of relevant ICD-10-CM codes and CPT II quality information in accordance with federal documentation and coding guidelines and appropriate UHC requirements
  • Routinely conduct chart reviews and consult with providers to provide feedback regarding missing or inadequate medical record documentation and to provide coding education
  • Ensure that member encounter data are being accurately documented and that correct procedure codes (e.g. AVCs) and all relevant diagnosis codes are captured
  • 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 member treatment information / 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)
  • Understand and present to providers Optum and UHC material related 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
  • 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 :

  • Certified Risk Adjustment Coder (CRC via AAPC) or either : Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist Physician-based (CCS-P via AHIMA)
  • with the requirement to obtain both certifications within first year in position (CRC within 6 months of hire and CPC within 1 year of hire, if not currently CPC or CCS-P)
  • 1+ years of experience in Risk Adjustment
  • Knowledge of ICD-10-CM and CPT II coding
  • Demonstrate a level of knowledge, skill and understanding of ICD-10-CM and CPT coding principles consistent with certification by AAPC or AHIMA
  • Advanced proficiency in MS Office (Excel, PowerPoint and Word)
  • Able to work effectively with common office software, coding software, EMR and abstracting systems
  • Preferred Qualifications :

  • Bachelor’s degree in Healthcare or relevant field
  • 3+ years of clinic or hospital experience and / or managed care experience
  • 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
  • Experience giving group presentations
  • Knowledge of EMR for recording member visits
  • Knowledge of billing or claims submission and other related actions
  • Ability to develop long-term relationships
  • Good work ethic, desire to succeed, self-starter
  • Solid 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
  • Excellent oral & written communication skills
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
  • To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment.

    In addition, some roles require full COVID-19 vaccination 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.

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