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Clinical Coding Consultant - Los Angeles County, CA

UnitedHealth Group

Los Angeles, CA
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Job Details

728174 Clinical Coding Consultant Los Angeles County CA

Clinical Coding Consultant - Los Angeles County, CA (728174)

Position Description

We are currently hiring a Coding Quality Consultant to cover the greater Los Angeles, Orange and San Diego areas of California.   You will be in the field consulting with physicians approximately 3 days per week and the other 2 days will be working from home.  This is a Monday - Friday position.  Candidates must reside in the greater Los Angeles and Orange County areas.


The Coding Quality Consultant (CQC) Coder demonstrates experience by correlating coding accuracy with correct HCC assignment.  The CQC Coder is responsible for conducting the audit to improve and increase members annual funding in order to drive better patient care and assist providers through education and training to improve RAF score accuracy.


The CQC Coder will comply with Coding and Corporate Compliance standards. Abides by ethical standards and adheres to official coding guidelines. The CPC Coder will perform other duties as assigned.  The individual in this role will perform the crucial task of assuring accuracy of codes from the listing of International Classification of Diseases, Tenth Revision; (ICD - 10 - CM).


Primary Responsibilities:

  • Targeting local providers who would benefit from our Medical Risk Adjustment training
  • Reaching out to physicians, medical groups, IPAs and hospitals, and building positive, consultative relationships
  • Educating providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
  • Developing comprehensive, provider - specific plans to increase their RAF performance
  • Training providers on our Risk Adjustment methods and tools, and working toward their compliance with our programs
  • Collaborating with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts
  • Conducts physician chart audits (including research and presentation). Assesses and interprets whether the coding assigned by the provider was properly assigned based upon review of the medical documentation and application of the coding guidelines
  • Identify potential suspects through clinical documentation where diagnosis is clinically indicated but not documented, discuss findings with providers for validation
  • Rely upon independent judgment and decision making while at a provider site, whether conducting an audit or providing training/education, both from historical and/or real time data
  • Able to field any questions or concerns and provide solutions that will mirror management’s guidelines
  • Implement education, and provide formal training to Client providers and staff as needed regarding coding compliance, documentation guidelines, HCC education and Medicare / Medicaid regulations by proactively providing solutions to meet the needs of the Client provider
  • Enhance professional growth and development through in-service meetings, and educational programs
  • Work independently and rely on professional discretion and judgment; as well as a professional representation of Client/Optum
  • Utilize management for escalation purposes
  • Maintain strictest confidentiality based on HIPPA privacy policy
  • Available to assist other team members in coding, HCC opportunities and act as a resource to less experienced staff
  • Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM knowledge
  • Reports to/works with the Associate Director of Clinical Quality & Coding
  • Provide feedback and present solutions, to the Associate Director of Clinical Coding and Quality, regarding trends or patterns noticed in provider coding
  • Schedule audits and provide patient lists to practice managers to promote a smooth audit process
  • Finalizing documentation and providing feedback to team members based on findings
  • Performs related work and projects as required

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • Must have completed coding certification course, AAPC/AHIMA, or other accredited certifying body, or completed college courses with degree in coding or currently enrolled in program for CPC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, or RHIT
  • Must possess a CCS, CPC or COC certification or will have it completed within next 90 days of employment
  • 3+ years of medical coding experience (after obtaining certification)
  • HCC coding experience
  • Must have experience auditing charts and consulting with providers on improving documentation and coding
  • Must have working knowledge of billing systems to understand how to identify potential black holes in claims submissions that might be causing lower risk adjustment scores to be reported inaccurately
  • Must have an excellent understanding of medical terminology, disease process and anatomy and physiology
  • Complete Understanding of ICD - 10 - CM coding classification and guidelines
  • Must have Computer skills (i.e. MS Office)
  • Must be task oriented and able to meet designated deadlines, productivity standards and able to work independently
  • Ability to travel locally to provider practices, will be out in field 75% with rare overnight stay required
  • Must reside within a commutable distance (50 miles or 50 minutes) of Los Angeles County

Preferred Qualifications:

  • Bilingual in Spanish, Vietnamese, Korean, and / or Farsi / Persian
  • Supervisory experience
  • Knowledge of Risk Adjustment HCCs
  • Previous consulting or sales experience

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)



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: risk adjustment, coding, coder, CPC, HCC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, RHIT, chart audit, ICD10, California, CA, Los Angeles, Anaheim, San Diego, Ontario, Carlsbad, Laguna Beach, Newport Beach, CA

Job Details

  • Contest Number728174
  • Job TitleClinical Coding Consultant - Los Angeles County, CA
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumInsight

Job Location Information

  • Los Angeles, CA
    United States
    North America
  • Other LocationsBeverly Hills, CA
    Torrance, CA
    Culver City, CA
    Santa Clarita, CA
    Long Beach, CA

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelYes, 50 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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