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Medicare Risk Adjustment and Coding Consultant - Colorado and Idaho

UnitedHealth Group

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Job Details

Medicare Risk Adjustment and Coding Consultant - Colorado and Idaho(Job Number:724922)

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)


The Medicare Risk Adjustment and Coding Consultant is a field-based position responsible for providing expertise in the area of quality and risk adjustment coding for provider clients. A Medicare Risk Adjustment and Coding 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 Risk Adjustment Coding 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.


*** Candidate must reside in Colorado or Idaho. The person in this role will be traveling up to 50% of the time through the Denver, CO airport ***


Primary Responsibilities:

  • Assists providers in understanding the Medicare 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
  • Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation / coding resources
  • The Medicare Risk Adjustment Coding Consultant will be responsible for facilitating and/or performing an audit of the providers’ medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately
  • Assist providers in understanding 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 scheduled 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.


Job Quality Management
Primary Location US-Colorado
Other Location US-Idaho
Organization RQNS Ops
Schedule Full-time
Number of Openings 1
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