PasadenaCARecruiter
the smart solution for Pasadena jobs

Field Based Coding Quality Consultant - Los Angeles County

Company: UnitedHealth Group
Location: Pasadena
Posted on: June 11, 2018

Job Description:

We are currently hiring a Coding Quality Consultant in Los Angeles County in California. This role will be in the field consulting with physicians at provider offices throughout Los Angeles County 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).

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 effortsRequired 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)

        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, California, CA, Los Angeles, Glendale, Pasadena, Santa Clarita, Burbank

        Department: Medical and Clinical Operations - provided by Dice Analysis, Anatomy, CCA, CMS, Consulting, Data Analysis, Development, Director, Genetic, Management, MS Office, Physiology, Research, Sales, Validation

        Keywords: UnitedHealth Group, Pasadena, Field Based Coding Quality Consultant - Los Angeles County, Professions, Pasadena, California

        Click here to apply!

        Didn't find what you're looking for? Search again!


        I'm looking for
        in category
        within


Other Professions Jobs


CDL-A Truck Driver - Housing Packages Available!
Description: Chalk Mountain is hiring experienced, local, Class A CDL truck drivers in West Texas. Earn up to 100,000 per year plus bonuses Great Home Time The perfect local oil and gas
Company: Chalk Mountain Services of Texas
Location: Bonita
Posted on: 06/24/2018

Commmercial Construction Overseer
Description: My Client is one of the Top Growing Commercial Construction Companies in the San Diego Area. They have a stellar reputation and work on interesting projects
Company: LavaRock LLC
Location: San Diego
Posted on: 06/24/2018

A Truck Driving job is waiting for you. Earn your Class A CDL today! - Long Beach
Description: Call for details 866-810-6543 br No Experience No Problem Start your Career Today br In as little as three weeks of sponsored training at an approved CRST facility, you'll be on the road, traveling (more...)
Company: CRST Expedited
Location: Long Beach
Posted on: 06/24/2018


CDL A Driver - Flatbed Owner Operator
Description: Owner Operators - CDL-A Solo Flatbed Drivers Bennett Motor Express has built our reputation on the integrity and character of our people. With over 40 years of experience in the industry, we've always (more...)
Company: Bennett Motor Express
Location: West Hills
Posted on: 06/24/2018

CDL-A Truck Driver - Earn Up to $100,000 Per Year!
Description: Chalk Mountain is hiring experienced, local, Class A CDL truck drivers in West Texas. Earn up to 100,000 per year plus bonuses Great Home Time The perfect local oil and gas
Company: Chalk Mountain Services of Texas
Location: San Ysidro
Posted on: 06/24/2018

CDL-A Truck Driver
Description: Chalk Mountain is hiring experienced, local, Class A CDL truck drivers in West Texas. Earn up to 100,000 per year plus bonuses Great Home Time The perfect local oil and gas
Company: Chalk Mountain Services of Texas
Location: Santa Fe Springs
Posted on: 06/24/2018

Lyft Driver - Get Paid the Same Day with Express Pay - $250
Description: What is Employer Employer matches drivers with passengers who request rides through the Employer smartphone app. Signing up to be a Employer driver is the perfect opportunity for you to set your
Company: Lyft
Location: Alpine
Posted on: 06/24/2018

ELECTRICAL CONSTRUCTION ESTIMATOR
Description: REQUIREMENTS: Minimum 5 years of experience as an electrical estimator for an electrical contractor Experience with large commercial, industrial, healthcare, convention
Company: Delta Construction Partners
Location: Los Angeles
Posted on: 06/24/2018

CDL-A Lease Purchase Truck Driver
Description: It Pays to Be an Owner Operator with HVH.When you have the right partner, it makes a difference. Having a partner that goes above and beyond to help you succeed is the HVH difference. We work with numerous (more...)
Company: HVH Transportation, Inc.
Location: Lemon Grove
Posted on: 06/24/2018

Dedicated CDL-A Local Truck Driver Position-Competitive Hourly Pay [252]
Description: Hub Group Dedicatedis in high need for CDL-A drivers in the Anaheim and Gardena, CA areas This is a local position, so enjoy excellent
Company: Hub Group
Location: Sierra Madre
Posted on: 06/24/2018

Log In or Create An Account

Username:
Password:
 

Forgot password?


Find us on Facebook

Find us on LinkedIn

Get the latest California jobs by following @recnetCA on Twitter!

Pasadena RSS job feeds