About UHG

Careers at UnitedHealth Group


We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

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Risk Adjustment Coding Educator- Local Travel - West Valley City, UT

UHG - West Valley City, Utah

Posted: 11/19/2018

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Are you ready for a new path? Start doing your life's best work.(sm)
This position is responsible for the direction and guidance on risk adjustment documentation to contracted network providers utilizing chart reviews, Optum metrics, and CMS guidelines emphasizing the importance of RAF and HCC recapture. Conducts clinical quality audits regarding CRC documentation following CMS guidelines. Responsible to report and analyze provider documentation quality and for the development of plans and programs to support continuous quality improvement. The Coding Educator provides support and works in conjunction with the Clinician Educator to facilitate meeting Optum’s overall goal of RAF improvement through quality documentation in the Utah market.
*This position requires local travel throughout the WVC / SLC market, Mon. - Fri.
General Job Profile
  • Reviews provider charts for documentation to support RAF recapture
  • Develops innovative approaches to facilitate the ongoing training of network providers and support staff
  • Sought out as expert on CMS coding regulations and guidelines
  • Serves as a resource for network managers, clinic staff, network providers and Clinician Educators
  • Conducts education to network providers and support staff
Job Scope and Guidelines
  • Familiarity with local market network providers, clinics, politics, and other factors influencing healthcare delivery in the Utah market
  • Establish and maintain professional relationships with all stakeholders
  • Serves as a key resource for network providers, network administrative and coding staff regarding RAF and coding guidelines
  • Continuously up to date on coding principles following CMS guidelines
  • Fluent and proficient in network database management using Optum software and various other applicable programs
  • Educate network providers, clinical and administrative staff on CMS coding and documentation guidelines through various formats (i.e. clinic visitation, RAF education events, small group coder session, one-on-one provider consultations)
  • Utilize individual chart reviews, Optum data, and approved education materials to develop training and educational interventions for network providers

Required Qualifications:
  • 2+  years of experience with Risk Adjustment and HEDIS / Stars
  • 2+ years of clinical experience, either hospital, ambulatory clinic and/or managed care experience
  • Undergraduate degree or equivalent experience required
  • Certified Professional Coder with American Health Information Management Association or American Academy of Professional Coders, CRC (Certified Risk - Adjustment Coder) or willingness to obtain required certification within the first year in the position
  • Knowledge of ICD-10
  • Strong proficiency in MS Office (Excel, PowerPoint, Word and Outlook)


Preferred Qualifications:
  • DataRAP, EnCoder and EMR / HER experience is preferred
  • Relationship sales background
  • Strong communication skills and demonstrated ability to work well with teams
  • Ability to formulate training materials designed to improve provider compliance
  • Ability to use independent judgment and discreetly manage and impart confidential information
  • Good work ethic, desire to succeed, self-starter and can work independently
  • Must be able to work effectively with common office software, market EMR systems, and reporting systems
  • Ability to develop and maintain long term business relationships
  • Ability to travel within the local market
  • Able to travel to network clinics during work day to provide educational training
  • Excellent oral and written communication skills, including experience giving group presentations
  • Ability to collaborate with individuals or teams to produce quality results
  • Strong business acumen and analytical skills
  • General knowledge of HEDIS/Stars guidelines and CPT 2 codes
  • Experience in a managed care or medical insurance setting
  • Good organization and planning skills, the ability to adhere to a full schedule
  • Ability to present complex data clearly and concisely to external clients
  • Willingness to become credentialed as a CPC-I during the course of this position in order to offer CEU to community/ market coders as defined by market needs as determined by clinical education team.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)
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 coder, coding educator, providers, outpatient clinics, Risk Adjustment Supervisor, Clinical Documentation Manager, Quality Improvement Supervisor, Quality Assurance, RHIT, CCS, CPC, AAPC, AHIMA, Medicare, CMS, Managed Care, hospital, ambulatory care, ICD-10, West Valley City, Salt Lake City, Utah, UT, Optumcare, UHG, UHC

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