National Coding Educator - Telecommute in Northeastern Region, US

Company: UnitedHealth Group
Location: Charlotte
Posted on: September 24, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The National Coding Educator acts as a provider engagement specialist. This is a field-based position responsible for providing expertise in the area of risk adjustment and quality coding for provider clients. A National Coding Educator 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 correct coding. He/She will also coordinate implementation of programs designed to ensure all diagnoses are coded in accordance with CMS and risk adjustment coding guidelines and all conditions are properly supported by appropriate documentation in the patient chart. The National Coding Educator will also ensure that providers understand the CPT II coding requirements for quality reporting under the Star Ratings program.

NOTE: Qualified candidates must live in the Northeastern Region of the US to qualify. States of Residency are limited to MI, IN, OH, KY, ME, NH, VT, MA, RI, CT, NY, NJ, PA, DE, WV, VA, and MD only.

If you are located in Northeastern Region, US, you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

• Partners with Healthcare Advocates in the field and will be assigned providers to consult and educate based on data analysis where they need support / training on improving documentation and coding accuracy
• Assists providers in understanding the Medicare Advantage quality program (HEDIS/STARS) as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation, diagnosis coding and quality reporting
• Utilizes analytics and identifies and targets providers for chart review
• Utilizes analytics and identifies target providers for Medicare Advantage Risk Adjustment training and documentation and coding education
• Facilitates and performs audits of the providers' medical charts to ensure appropriate documentation that supports the diagnoses submitted
• Ensures that provider documentation supports the submission of relevant ICD-10-CM and CPT II codes, when appropriate, in accordance with national coding guidelines
• Routinely consults with medical providers to provide feedback regarding identified coding errors and omissions and deliver targeted coding education
• Ensures member encounter data (diagnoses and quality care) is being accurately documented and relevant diagnosis and quality codes are being captured
• Provides thorough, timely and accurate consultation on ICD-10-CM and/or CPT II coding by providers or practice clinical consultants
• Provides ICD-10-CM and CPT II coding training to providers and appropriate staff
• Develops and presents coding presentations and training to small and large groups of clinicians, practice managers and certified coders, customizing training to fit specific provider's needs
• Develops and delivers diagnosis coding tools and quality reporting tools to providers, coders and billers
• Trains physicians and other staff regarding documentation and coding and provides feedback to physicians regarding documentation practices
• Educates providers and staff on coding regulations and changes as it relates to Risk Adjustment and Quality Reporting to ensure compliance with state and federal regulations
• Performs analysis and provides formal feedback to providers as indicated or as requested
• Provides measurable, actionable solutions to providers that will result in improved accuracy in documentation and coding practices
• Reviews selected medical documentation to determine if diagnosis codes and quality reporting codes are appropriately assigned
• Assesses adequacy of documentation and trains Provider office staff on Provider queries to clarify documentation to ensure accurate and complete coding
• Collaborates with providers, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality Reporting education efforts
• Participates in the interview and selection process for Optum Approved Trainers
• Provides ongoing educational support for Optum Approved Trainers
• Participates in Optum tool and presentation creation and in the annual update process to ensure timely completion and delivery of materials
• Works with Optum Approved Trainers during annual tool and presentation updates
• Facilitates and presents during the Optum National Coding Forum
• Collaborates with fellow National Coding Educators on a regular basis You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
  
  Required Qualifications:
  • Certified Risk Adjustment Coder (CRC) and either Certified Professional Coder (CPC) with AAPC or CCS-P with AHIMA with the requirement to obtain the AAPC Approved Instructor credential within 6 months
  • 5+ years of coding training experience training providers, coders, and billers
  • 4+ years of experience in Risk Adjustment and/or HEDIS/Stars Provider education
  • 4+ years of clinic or hospital experience and/or managed care experience
  • Advanced proficiency in MS Office (Excel Pivot tables, excel functions , PowerPoint and Word)
  • Experience working effectively with common office software, coding software, EMR and abstracting systems
  • Willing to travel at least 50% of the time for onsite training and education as business needs dictate (all travel is within the Northeastern region of the US)
  • Ability to provide proof of a valid, unrestricted Driver's License and current Auto Insurance
  • Live in the Northeastern Region of the US to qualify (States of Residence that meet this requirement are limited to MI, IN, OH, KY, ME, NH, VT, MA, RI, CT, NY, NJ, PA, DE, WV, VA, and MD only)
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications:
    • Bachelor's Degree (preferably in Healthcare or relevant field) or equivalent experience
    • Master's Degree or equivalent experience
    • Certified Professional Medical Auditor (CPMA) certification preferred
    • Experience in management position in a provider practice
    • Knowledge of EMR for recording patient visits
    • Knowledge of billing/claims submission and other related processes Soft Skills:
      • Excellent oral & written communication skills
      • Experience giving group presentations
      • Strong business acumen and analytical skills
      • Ability to deliver training materials designed to improve provider compliance
      • Ability to develop long-term relationships
      • Good work ethic, desire to succeed, self-starter
      • Ability to use independent judgment, and to manage and impart confidential information To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
        
        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..... click apply for full job details

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