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Medicare Consultant - Colorado

UnitedHealth Group

Denver, CO
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Job Details

739659 Medicare Consultant Colorado

Medicare Consultant - Colorado (739659)

Position Description

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.  He / She 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 the providers understand the STARS CPT2 coding requirements.  This position will function in a matrix organization taking direction about job function from UHC and M&R but reporting directly to Optum Insight.


If you are located in Colorado, you will have the flexibility to telecommute* as you take on some tough challenges.


Primary Responsibilities:

  • Assists providers in understanding the Medicare Stars quality program as well as CMS -HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

  • Utilizes analytics and identifies and targets providers

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

  • Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources

  • Assist providers in understanding the Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

  • Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

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

  • Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured

  • Provides thorough, timely and accurate consultation on ICD-10 and/or CPT 2 codes by providers or practice clinical consultants

  • 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

  • ProvidesICD10 - HCC coding training to providers and appropriate staff

  • Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs

  • Develops and delivers diagnosis coding tools to providers

  • Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians 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 a regularly scheduling basis

  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

  • Reviews selected medical documentation to determine if assigned diagnosis, procedures codes and ICD-10 codes are appropriately assigned

  • 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 doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts


Required Qualifications:

  • Previous experience in Risk Adjustment and HEDIS / Stars 
  • Certified Professional Coder with American Health Information Management Association or American Academy of Professional Coders
  • CRC (Certified Risk Coder) or willingness to obtain required certification within first year in position
  • Minimum 4 years of clinic or hospital experience and/or managed care experience
  • Knowledge of ICD10
  • Intermediate proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)

Preferred Qualifications: 

  • Demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders
  • Knowledge of EMR for recording patient visits
  • Previous experience in management position in a physician practice
  • Minimum of one year of coding performed at a health care facility
  • Knowledge of billing/claims submission and other related actions
  • Must be able to work effectively with common office software, coding software, EMR and abstracting systems
  • 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 formulate training materials designed to improve provider compliance
  • Ability to use independent judgment, and to manage and impart confidential information

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)


*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, CRC, Denver, CO, Colorado, Colorado Springs


Job Details

  • Contest Number739659
  • Job TitleMedicare Consultant - Colorado
  • Job FamilyNetwork Management
  • Business SegmentOptumInsight

Job Location Information

  • Denver, CO
    United States
    North America
  • Other LocationsColorado Springs, CO
    Pueblo, CO
    Greeley, CO
    Boulder, CO

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • 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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