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Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Coding Quality Consultant - Bakersfield, CA

UHG - Fresno, California

Posted: 12/13/2018

We are currently hiring a Coding Quality Consultant to cover Bakersfield/Fresno, CA and surrounding areas.   You will be in the field consulting with physicians approximately 80% of the time, Monday through Friday. 

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).

If you are located in Bakersfield / Fresno, CA area, you will have the flexibility to telecommute* as you take on some tough challenges. The role is based out of employee's home but will be required to work in the field at least 80% of the time

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
  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
  • Will be out in the field 80% of time in defined territory with rare occasion of overnight travel
  • Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
  • Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity
  • Consult with provider/office staff on gaps in documentation and coding
  • Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding
  • 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
  • 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
  • Provides ICD10 - HCC coding training to providers and appropriate office staff as needed
  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
  • Collaborates with Healthcare Advocates on team on a wide scope of Risk Adjustment education efforts

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • Must have completed coding certification course, AAPC/AHIMA, or other accredited certifying body, or CPC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, or RHIT
  • Must possess a CCS, CPC or COC certification
  • 4+ years of hands-on medical coding experience, post certification
  • 1+ year of hands-on experience with Risk Adjustment HCCs
  • Must have experience auditing charts and consulting with providers on improving documentation and coding
  • Must have working knowledge of billing systems to understand how to identify potential black holes in claims submissions that might be causing lower risk adjustment scores to be reported inaccurately
  • Must have an excellent understanding of medical terminology, disease process and anatomy and physiology
  • Complete Understanding of ICD - 10 - CM coding classification and guidelines
  • Must have Computer skills (i.e. MS Office)
  • Must be task oriented and able to meet designated deadlines, productivity standards and able to work independently
  • Ability to travel locally to provider practices, will be out in field  80% of the time, with rare overnight stay required
  • Must have a dedicated, distraction-free space in home for home office
  • Must have access to high-speed internet (DSL or Cable)
Preferred Qualifications:
  • Bilingual in Spanish, Vietnamese, Korean, and/or Farsi/Persian
  • Supervisory experience
  • Previous consulting or sales experience

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: risk adjustment, coding, coder, CPC, HCC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, RHIT, chart audit, ICD10, Bakersfield, Fresno, CA, California

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