Job Description

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

The Clinical Quality Analyst is expected to work directly with physicians and mid-level providers to proactively review medical records and other clinical documentation to identify possible risk adjustment codes. The major focus of this position will be to collect and review documents to support physician's healthcare management and the company's risk adjustment initiatives.

Primary Responsibilities:

* 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

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:

* RN license OR non-licensed medical school graduate
* CRC certification OR proof that certification can be obtained within 1 year of employment from the American Academy of Professional Coders
* Proficiency with Microsoft Office applications: Word, Excel, PowerPoint and Outlook
* Access to reliable transportation, and willingness to Regionally travel 50% as necessary to complete off-site data mining and screening exam duties

Preferred Qualifications:

* Bachelor's degree
* Prior coding experience
* Experience audition quality assurance
* Experience in chart review
* Experience with medical review process
* Knowledge of medical terminology
* Knowledgeable in medications and treatments prescribed in a primary care office
* Knowledge of ICD-10 codes
* 3+ years of experience working with Medicare/Medicaid

Physical & Mental Requirements:

* Ability to lift up to 25 pounds
* Ability to sit for extended periods of time
* Ability to use fine motor skills to operate office equipment and/or machinery
* Ability to receive and comprehend instructions verbally and/or in writing
* Ability to use logical reasoning for simple and complex problem solving

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 350,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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: Clinical Quality Analyst, WellMed, Quality audits, CRC, chart reviews, medical review process, medical terminology, ICD-10 codes, CMS guidelines, Corpus Christi, Victoria, Kingsville, TX, Texas