- Provide analytical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups
- Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional/Market operations
- Assist in developing of training and analytical materials for Risk Adjustment
- Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings / JOCs
- Lead Weekly, Monthly, Bi-monthly, Quarterly, and/or Annual Business Review meetings related to Risk Adjustment activities which summarize provider group performance and market performance as requested by or required by Market leadership
- Analyze Provider and Group performance regarding Risk Adjustment and Focus on Care (FOC) to determine areas of focus or improvement opportunities.
- Develop solution-based, user friendly initiatives to support practice success
- Oversee market specific chart retrieval and review of PCP, Hospital, and Specialist records
- Work with DataRAP Senior Leadership on identified special projects
- 5+ years associated nursing experience within health care industry
- Solid knowledge of the Medicare market, products and competitors
- Knowledge base of clinical standards of care and preventative health measures
- Proven ability and willingness to travel (locally and non-locally) as determined by business needs
- Experience in managed care working with network and provider relations
- Additional Medical chart review experience
- Medical/clinical background
- Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
- Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
- Proven ability to solve process problems crossing multiple functional areas and business units
- Proven solid presentation skills and relationship building skills with clinical/non-clinical personnel
- Proven good business acumen, especially as it relates to Medicare
- Proven MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
-
UnitedHealth Group Inc San Antonio, TX, United StatesRN Clinical Coding Nurse Consultant WellMed San Antonio Texas · Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achi ...
-
Rn Clinical Coding Nurse Consultant Wellmed San
2 weeks ago
Optum San Antonio, United States**Opportunities at WellMed**, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinica ...
-
Regional Director of Facilities Management
2 weeks ago
Touchstone Communities Shavano Park, United States· Director of Environment of Care (Facilities Management)- Skilled Nursing · *** Must have Regional/Multi-facility experience in the skilled nursing industry ** · Join our family. Make a meaningful difference. Become a part of The Team and contribute to our Mission of Serving Ot ...
-
Billing Representative
1 week ago
Christus Health San Antonio, United States· Summary: · Under the general direction of the Practice Manager, theBilling Specialist is responsible for monitoring HOPD departmentalbilling processes and makes corrections as needed. Manages thetimely and accurate posting of physician charge data for bothpatient and client –b ...
-
Compliance Reviewer
1 week ago
Texas Department of Aging & Disability Services San Antonio, United StatesJob Description: · This position's headquarters can be located in any available HHSC LTCR office in the state of Texas and reports to the Quality Assurance Regional Program Manager. · Under the supervision of the Quality Assurance Regional Programs (QARP) Manager, the QARP Compli ...
-
Licensed Clinical Psychologist
3 weeks ago
NURSES Etc STAFFING San Antonio, United StatesNurses Etc Staffing is partnering with Joint Base San Antonio to provide a full-time Clinical Psychologist to join our team at Lackland AFB, TX. · Clinical Psychologist Perks: Excellent compensation · Clinic hours · Malpractice paid by the Government · Any active license is ac ...
-
Counselor
3 weeks ago
Archdiocese of San Antonio San Antonio, United States Part timeFLSA Status: Part-time · Reports to: Principal · Summary: · The School Counselor, under the supervision of the Principal and the Vice-Principal, is employed to provide educational, career, social, and personal counseling for all students in order to support each child's optima ...
-
Coordinator Referrals
3 weeks ago
Christus Health San Antonio, United States· Summary: · This position is responsible for coordinating the entirereferral process (obtaining order from physician, obtaininginsurance authorization from the insurance company/payor,scheduling the appointment for the patient with a physician whoaccept the particular insurance ...
-
Substation Engineer
3 weeks ago
Westwood San Antonio, United States RegularOverview · Substation Engineer - P&C · Westwood Professional Services, Inc. · Westwood Professional Services, Inc. is seeking a Substation Engineer - P&C to join our team. The Substation P&C Engineer serves as an engineer on electric substation design projects for high-voltag ...
-
Salesforce Developer
3 weeks ago
Innova Solutions San Antonio, TX, United StatesInnova Solutions is immediately hiring a Salesforce Developer. · Position type: Full-time- Contract · Duration: 12+ Months · Location: San Antonio, TX · As a Salesforce Developer, you will: · As a Salesforce Developer, you will apply your expertise to help shape the future o ...
-
Facilities Accreditation
2 weeks ago
Cherokee Nation Businesses San Antonio, United States Part timeFacilities Accreditation & Compliance (FAC) Specialist · Support the DHA Program Manager and the Physical Environment and Life Safety Accreditation technical advisors and Subject Matter Experts (SMEs) for DHA Facility Operations Branch (FOB). DHA's area of responsibility (AOR) i ...
-
Sr. PG Project Manager
2 weeks ago
MassGenics San Antonio, United States ContractInnova Solutions is immediately hiring for a Sr. PG Project Manager. · Duration: 9 months · Position Type: Contract · Location: San Antonio, TX · As a Sr. PG Project Manager, you will: · Manges the planning, design, and construction of multiple capital and/or O&M projects (e.g., ...
-
School Speech Language Pathologist
3 weeks ago
HealthPRO Heritage San Antonio, United States Regular Full timeOverview · SCHOOL SPEECH LANGUAGE PATHOLOGIST SY · Join our Pediatric School Based Team, and use your passion for Speech Therapy to help make a difference in a child's life · School Speech Language Pathologist position available to begin Aug 2024 · San Antonio, TX · Full Time ...
-
DEF Definitive Logic San Antonio, United States Full timeSecure our Nation, Ignite your Future · Become an integral part of a diverse team while working at an Industry Leading Organization, where our employees come first. At ManTech International Corporation, you'll help protect our national security while working on innovative projec ...
-
St. PJ's Children's Home San Antonio, United StatesDescription · Summary: · The Coach fulfills the mission of the Catholic school by developing, initiating, and administering the program in a particular sport which adequately prepares the student athlete for interscholastic competition. The Coach is recommended to the principal ...
-
Seasonal Coach
3 weeks ago
St. PJ's Children's Home San Antonio, United StatesDescription · FLSA Status: Seasonal/Exempt (unless specified otherwise) · Summary: · The Coach fulfills the mission of the Catholic school by developing, initiating, and administering the program in a particular sport which adequately prepares the student athlete for interscho ...
-
Community Liaison
2 weeks ago
Touchstone Health San Antonio, United States Full timeTouchstone Health, part of the Touchstone Communities family of healthcare companies, is seeking a connected Community Liaison to join our marketing team. The ideal candidate will develop appropriate referrals through the selection, acquisition, retention and growth of business p ...
-
Certified Pharmacy Technician I
2 weeks ago
CHRISTUS Childrens Hospital San Antonio, United States PRNJob Description · Summary: · All pharmacy technicians work under the direction of Clinical Pharmacists to provide pharmacy services with compassion, excellence, and efficiency. · The CHRISTUS Children's Hospital, established in 1959, was the first children's hospital in South-C ...
-
Locum Certified Registered Nurse Anesthetist
2 weeks ago
LocumJobsOnline San Antonio, United States Full timeLocumJobsOnline is working with Adelphi Medical Staffing to find a qualified Anesthesiology CRNA in Houston, Texas, 77030 · About The Position · Seeking a Certified Registered Nurse Anesthetists (CRNAs) to provide comprehensive clinical anesthesiology services at a medical center ...
-
Warehouse Associate
3 weeks ago
Orora San Antonio, United StatesAt Orora, we believe our packaging touches lives and together, we, together as a team, deliver on the promise of what's inside. From custom packaging design and packaging materials, to prototype development and manufacturing, packaging automation and equipment, kitting and fulfil ...
RN Senior Clinical Coding Consultant - San Antonio, TX, United States - UnitedHealth Group Inc
Description
RN Clinical Coding Nurse Consultant WellMed San Antonio TexasOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health.
With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring.
Clinical Coding Nurse Consultant will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered.
Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives.
This position will provide direction and guidance to Medical Coding Analysts, as well as cross functional team members within their respective Markets pertaining to Risk Adjustment.
Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metricsYou'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.
Bachelor's degree in Nursing (Associate's degree or Nursing Diploma from accredited nursing school with 2+ years of additional experience may be substituted in lieu of a bachelor's degree) and current RN license in good standingAt UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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.
RN Senior Clinical Coding Consultant professionals in San Antonio
-
Ingrid Glueck-Maldonado
Chief Financial Officer