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 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
- Performs all other related duties as assigned
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.
- RN or 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-yr from the American Academy of Professional Coders
- Knowledge of Medical Terminology
- Able to communicate with all levels of the organization
- 3 years of experience working with Medicare/Medicaid
- Flexibility and willingness to shift priorities as often as needed to minimize issues or meet market goals and objectives
- Willing to travel as necessary to complete off-site data mining and screening exam duties.
- Knowledgeable in medications and treatments prescribed in a primary care office
- Basic knowledge of ICD-10 codes
- Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Bachelor’s degree
- 2+ years of coding experience
- Additional Quality Assurance auditing experience
- Additional Chart Review Experience
- Ability to multi-task in a fast paced and deadline driven environment
- Ability to maintain professionalism and a positive service attitude at all times.
- Ability to effectively report data, facts and recommendations in oral and/or written form
- Ability to analyze facts and exercise sound judgment when arriving at conclusions
- Strong attention to detail and excellent organizational skills
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 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: Medical Records Review, Medical, Healthcar, US Healthcare, El Paso, Texas, TX