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Clinical Coding Consultant - Los Angeles County, CA

UnitedHealth Group

Los Angeles, CA
Job Code:
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Job Details

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

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

Job Medical Coding
Primary Location US-CA-Los Angeles
Other Location US-CA-Glendale, US-CA-Beverly Hills, US-CA-Torrance, US-CA-Long Beach, US-CA-Santa Clarita, US-CA-West Hollywood, US-CA-Culver City, US-CA-Pasadena, US-CA-Burbank
Organization RQNS Ops
Schedule Full-time
Number of Openings 1
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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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