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HCC/Risk Medical Coding Analyst – Colorado

UnitedHealth Group

This is a Full-time position in Atlanta, GA posted April 29, 2021.

Opportunities with New West Physicians. Bring your passion for health care to New West Physicians in Colorado, a team committed to providing excellent service to every patient… every time. We’re not only one of the largest physician groups in Colorado with 21 offices throughout the Denver Metro area—we’re also part of Optum, a nationwide family of over 53,000 dedicated physicians working together to help people live their healthiest lives. That means we’re backed by the resources of a global health care organization working to help people live healthier lives and help make the health system work better for everyone. New West Physicians has received national awards for providing high quality health care in Colorado.  It’s all possible because of our highly qualified, board-certified family practice and internal medicine physicians, hospitalists, cardiologists, gastroenterologists, psychiatrists, endocrinologists, neurologists, physiatrists, physician assistants, nurse practitioners—and more. If this sounds like the place for you, it’s time to take a closer look at New West Physicians and discover a path to your life’s best work. (sm)

Review documentation to assure proper application of ICD-10 coding/risk adjustment guidelines and policies are being met. Application of appropriate CPT, CPT II, HCPCS, and modifiers necessary for accurate charge submission and reimbursement. Maintain defined charge submission turnaround times. Query providers for documentation clarification. Communicate with providers and clinic staff on a regular basis regarding documentation, coding and billing related issues.

If you are located in the greater Denver area, you will have the flexibility to telecommute* as you take on some tough challenges. Telecommuting from out of state is not possible for this position.

Primary Responsibilities:

  • Performs concurrent review of provider documentation, diagnoses and charge codes for Medicare Advantage members for assigned providers or sites to ensure proper ICD-10, CPT, CPTII, HCPCS and modifiers are applied.
  • Query providers or clinic staff as necessary for clarification of documentation or lack thereof as it pertains to proper application of ICD-10 HCC diagnosis codes.
  • Reviews additional chart details and documentation as necessary to ensure proper diagnoses codes are applied; including reviewing orders, pathology, radiology, labs and other test results.
  • Responsible for identifying/extracting any additional documented HCC diagnosis not coded by provider for reviewed encounter.
  • Will work out of multiple systems including: Touchworks EHR, Allscripts PM and DataRaps applications
  • Conducts physician chart audits for HCC coding as requested (includes research and presentation of finding and correct coding principles).
  • Expected to maintain a coding accuracy level of 95%.
  • Maintains turnaround times as defined by Manager.
  • Assists billing office staff with claims denials and corrections for re-billing purposes as needed.
  • Conducts training sessions for physicians on relevant topics or updates, such as documentation guidelines, Medicare/Medicaid regulations, and documentation and coding requirements for HCC/risk adjustment.
  • Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM, CPT, and HCPCS II materials.
  • Performs other miscellaneous duties as 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.

  • High School Diploma or equivalent with knowledge of medical terminology
  • Certified Professional Coder (CPC) or (CRC) certificate
  • 2 years of experience in physician coding and/or reimbursement activities with previous HCC coding experience
  • Extensive understanding of CMS risk adjustment model and HCC coding guidelines
  • Chart auditing experience
  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role.
  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

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)

Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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. Optum is a drug-free workplace. © 2020 Optum. All rights reserved.