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Manager, Risk Coding
Location:
Tampa, FL
Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. This function provides coding and coding auditing services directly to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes. Demonstrates experience by correlating coding accuracy with correct HCC assignment for MA/Risk and/or CPT, ICD-10, HCPCS and Modifiers for FFS. Complies with all aspects of Coding and Corporate Compliance standards. Abides by all ethical standards and adheres to official coding guidelines. This is a Hybrid role requiring 2 days per week onsite at our Tampa Corproate Office. Primary Responsibilities: Develops overarching strategies for the analytical and specialized coding processes for the department Sets the fundamental direction of executing these strategic plans with the team Manages, guides, and supports the overall work of the team to maximize results by providing subject matter expertise and training Oversees work activities of others (e.g., staff, team leads, supervisors) and is the point of contact for escalated coding related matters and concerns Adapts departmental plans and priorities to address business needs and operational challenges Gathers relevant data and analyzes information to resolve complex billing/coding issues and determine the root cause for coding discrepancies Reconcile discrepancies identified on coding correction and held voucher reports Generate and/or distribute reports and documentation to leadership team and/or ancillary departments Demonstrate understanding of relevant systems and coding software applications (e.g. Practice Management Systems, EMRs, MS Office, Medical Coding software) Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information Follow up with providers as necessary when responses to queries are not provided in a timely basis Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions) Maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current HCC and/or CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters) Resolve medical coding edits or denials in relation to code assignment Perform medical coding audits to evaluate medical coding quality and review results Provide information or respond to questions from medical coding quality audits and utilize results to identify potential corrections/enhancements to the coding processes Follow steps per agreement with medical coding audit results to resolve discrepancies Provide resources and information to substantiate medical coding audit findings Educate and mentor others to improve medical coding quality Apply understanding of National Correct Coding Edits to the coding process Demonstrate understanding of National and Local coverage determinations Demonstrate basic knowledge of the impact of coding decisions on revenue cycle Demonstrate understanding of relevant terminology required for coding Follow relevant professional code of ethics consistent with required certifications Attain and/or maintain relevant professional certifications and continuing education seminars as required Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Ability to travel may be required 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: AAPC or AHIMA approved coding certification program CPC, CRC or RHIT certification 3+ years of coding experience in a Primary Care/Specialty environment 3+ years of Management experience Preferred Qualifications: Primary Care Physician coding experience Risk Adjustment/HCC coding experience Experience working within an EMR Knowledge of Fee for Service, Medicare, Medicare Advantage, and Health Maintenance Organization (HMO) payer guidelines Knowledge, Skills, Abilities: Ability to oversee the daily responsibilities of the Coding department, while setting goals and priorities for the team Must have an excellent understanding of medical terminology, disease process and anatomy and physiology Must have an excellent understanding of ICD-10-CM coding classification and guidelines Must have an excellent understanding of CPT, HCPCS and Modifiers coding and guidelines within a primary care environment Must have Computer skills (i.e. MS Office, Power Point) Must have good organizational and communication skills Must be task oriented and able to meet designated deadlines and productivity standards Must have solid Interpersonal skills and excellent Customer Service skills Ability to present a professional image when interacting with all levels of staff Ability to write reports, business correspondence and procedures Ability to effectively present information and respond to questions from government entities, employees, leadership team, and physicians Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations Ability to recognize, evaluate, solve problems, and correct errors, and to develop processes that eliminate redundancy Ability to work under minimum supervision and demonstrate solid initiative Ability to deal in an organized manner with problems involving multiple variables within the scope of the position Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding Coding and other office duties Ability to conceptualize workflow, develop plans, and implement appropriate actions At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Requisition #: 22213876ahf9io63
Company:
Unitedhealth Group
Posted:
April 25 on InsuranceJobs
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More About this Listing: Manager, Risk Coding
Manager, Risk Coding is a Executive Manager Job at Unitedhealth Group located in Tampa FL. Find other listings like Manager, Risk Coding by searching Oodle for Executive Manager Jobs.
Manager, Risk Coding is a Executive Manager Job at Unitedhealth Group located in Tampa FL. Find other listings like Manager, Risk Coding by searching Oodle for Executive Manager Jobs.