United Healthcare Careers – Medicare Consultant

Website United Healthcare

Job Description:

The Medicare Consultant is responsible for providing expertise in the area of primarily risk adjustment coding for provider clients. The Medicare Consultant supports the work of the Practice Performance Manager in discussing coding for quality performance reporting.  A Medicare Consultant will interact with operational and clinical leadership to assist in identification of operational and clinical best practices in understanding and assessing chronic condition suspects, appropriate clinical documentation and accurate coding.  The Medicare Consultant will facilitate implementation of programs designed to ensure all diagnoses are supported by appropriate documentation in the member chart and correct coding according to the CMS, the CDC and official risk adjustment coding guidelines. The Medicare Consultant will also ensure that providers understand CPT II coding for the CMS Medicare Advantage Star Ratings program.  This position functions in a matrix organization taking direction about job function from UHC M&R but reporting directly to OptumInsight.

Job Responsibilities:

  • Assist providers in understanding the CMS-HCC risk adjustment model as it relates to payment methodology and the importance of proper chart documentation and coding of procedures (e.g. Annual Care Visits [ACVs]) and diagnoses
  • Assist providers in understanding the MCAIP incentive program, the CMS-HCC risk adjustment model and payment methodology, and the CMS Medicare Advantage Star Ratings program and the importance of proper chart documentation and coding of certain procedures (e.g. ACVs), diagnoses and quality reporting codes
  • Utilize analytics to identify providers with the greatest opportunity for improved reporting, for Medicare Risk Adjustment and documentation and coding training utilizing UHC and Optum documentation/coding resources
  • Assist providers in understanding coding for the CMS Medicare Advantage Star Ratings quality program – CPT II coding, the coding for Frailty and Advanced Illness Exclusions and any future coding topics, whenever applicable to a measure
  • Interface with the HEDIS Quality incentive and team members
  • Understands risk adjustment, audits medical records and presents feedback to providers in order to increase specificity with their coding and documentation
  • Monitor appropriate chart documentation and consult with providers on correct coding practices that promotes improved healthcare outcomes
  • Prepare, deliver and follow up with providers on action driven reporting
  • Provides coding and risk adjustment strategy to providers engaged in Medicare and Medicaid Health Plan incentive programs

Job Requirements:

  • Proficiency in MS Office (Word, Excel, and PowerPoint)
  • Knowledge of ICD-10-CM and CPT II coding
  • CRC (Certified Risk Adjustment Coder), or ability to obtain within 6 months of hire
  • CPC (Certified Professional Coder) or CCS (Certified Coding Specialist), or ability to obtain within 12 months
  • Currently hold some type of coding certification

Qualification & Experience:

  • 3+ years of clinic/hospital experience and/or managed care experience
  • 1+ years of experience in Risk Adjustment
  • Experience working with coding software
  • Experience working with EMR’s

Job Details:

Company: United Healthcare

Vacancy Type: Full Time

Job Location: Tampa, FL, US

Application Deadline: N/A

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To apply for this job email your details to bfdirb6788@gmail.com