The Medical Records Reviewer is expected to work directly with Physicians and Midlevel Providers to proactively review medical records and other clinical documentation to identify possible risk adjustment codes. The Major focus of the Medical Records Reviewer will be to collect and review documents to support physician’s healthcare management and the company’s risk adjustment initiatives.
- Review medical record documents and other clinical documentation in provider’s charts to identify possible risk adjustment codes
- Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process
- Manage multiple provider office reviews simultaneously and collaborate with supervisor and office administrator to ensure clarity of review and to allow feedback from the provider office
- Track, report, and monitor code-submissions using program forms and processes
- Coordinate with supervisor to develop and present reports of medical record reviews to present to physician's office staff
- Progress relationship with Provider’s office to allow on-site screening if required in order to help physician meet quality program goals and potential need for RAP initiatives in each office
- Analyze errors in submission sent to quality department by physician office and notify Supervisor for process improvement plan
- Work with network managers, medical director, market leader, cross functional team and other stakeholders to improve coding accuracy
- Assist with HEDIS and stars quality performance improvement activities
- Performs all other related duties as assigned
- Non - licensed medical school graduate
- Familiar with medical review process
- Experience in a clinical setting
- CPC certification or proof that certification has been obtained within 1 year from the American Academy of Professional Coders
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.