Senior Clinical Coding Nurse Consultant North Texas Market

UnitedHealth Group; Irving (TX); On-site; Confidential; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group, including WellMed, seeks a Senior Clinical Coding Nurse Consultant (Sr. CCNC) to lead Risk Adjustment practices. You will guide DataRAP operations, educate regions on HCC guidelines, and collaborate with clinicians to enhance RA reporting and care quality.

This role emphasizes compliance, data-driven decision making, and cross-team coordination. The ideal candidate is a licensed RN with CPC certification, strong CMS/HCC knowledge, and the ability to travel locally and beyond.

Qualifications

• RN license (current, unrestricted)
• Bachelor's degree or substitution with 4+ years RN nursing experience
• CPC certification within 9 months of hire
• Understanding of CMS HCC Model, Medicare Advantage, and ICD-10-CM guidelines
• Strong communication, time management, and independent work skills
• Proficiency with MS Office 365 (Excel, PowerPoint, OneNote)
• Willingness to travel locally and non-locally (DFW area preferred)

Responsibilities

• Act as subject matter expert for RA activities in assigned market(s) and matrix environment
• Collaborate with clinicians and leadership on RA reporting to improve member care
• Provide analytical interpretation of RA reporting
• Educate/train on RA metrics with central/regional teams
• Participate in RA Chart Retrieval Project to collect provider charts
• Attend regularly scheduled Business Review meetings on RA activities
• Evaluate provider group operations to optimize RA workflows
• Develop user-friendly RA solutions with regional and central leaders
• Assist DataRAP senior leadership on special projects
• Perform other RA duties as assigned

Skills

CMS HCC Model

Medicare Advantage

ICD-10-CM guidelines

Critical thinking

Time management

Independent work

Verbal/written communication

MS Office 365

Travel

Live in DFW area

Driver's License

Education

Bachelor of Science in Nursing

Associate degree in nursing with substitution

Tools

CPC Certification

Job description

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Senior Clinical Coding Nurse Consultant (Sr. CCNC) represents the Risk Adjustment (RA) Department by implementing consistent, compliant RA best practices for the Central and Regional DataRAP Operations teams. Working in concert with central and regional leadership, clinicians, and market teams, the Sr. CCNC offers education and support to the regions regarding DataRAP processes, coding documentation, Hierarchical Condition Category (HCC) coding guidelines, and HCC metrics. Adhering to RA compliance standards and initiatives, the Sr. CCNC shares their expert knowledge of reporting applications, providing intuitive workflows that enhance time efficiencies and ultimately improve care for our members.

This position requires close collaboration with central, regional and leadership teams within a matrix structure. It demands a high level of collaboration to ensure that RA practices are compliantly implemented and maintained across the enterprise.

The customers served by this role include the DataRAP team, clinicians and staff, and business leaders.

Primary Responsibilities:

• Subject matter expert for all RA related activities within their assigned market(s) working within a matrix relationship, which includes DataRAP Operations and regional/market operations
• Collaborate with clinicians and leadership on RA reporting to assist in facilitating improved care to our membership
• Provide analytical interpretation of RA reporting
• Educate and train on RA metrics in collaboration with central and regional teams. The scope may include large hospital systems, medical groups and individual clinicians
• Participate in the RA Chart Retrieval Project to provide robust data on each member to include primary care provider, hospital and specialist charts
• Participate in scheduled meeting with clinician groups on weekly, monthly, quarterly, and annual Business Review meetings related to RA activities, which summarize the clinicians care to our members via RA reporting
• Analyze and evaluate a provider group operation to identify the most effective workflow in relationship to RA processes
• Develop solution-based, user-friendly initiatives in collaboration with central and regional leaders to support practice success
• Work with DataRAP senior leadership on identified special projects
• Perform 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.

Required Qualifications:

• Bachelor of Science in Nursing with 2+ years of clinical Registered Nurse (RN) experience or an associate's degree in nursing with 4+ years of clinical nursing experience may be substituted in lieu of a bachelor's degree.
• Must hold a current, unrestricted RN license in good standing
• Certified Professional Coder (CPC) Certification: Must be obtained within nine months of the hire date from the American Academy of Professional Coders. Certification expenses are funded by the organization
• Knowledge Requirements:
  • Understanding of the CMS HCC Model, Medicare Advantage, and ICD-10-CM guidelines
  • Critical thinker; adept at analyzing complex issues, drawing insightful conclusions, and devising effective action plans
  • Demonstrated solid time management skills, highly capable of working independently
• Communication: Demonstrated solid verbal and written skills. Ability to collaborate effectively with diverse team
• Computer Skills: Intermediate level ability: MS Office 365, One Note, Excel and PowerPoint
• Travel: Ability and willingness to travel (both locally and non-locally) as determined by business needs
• Live in DFW area
• Driver's License and access to reliable transportation

Preferred Qualifications:

• Experience in CMS HCC model, managed care and provider relations
• Additional medical chart review experience
• Adept at building solid relationships with healthcare partners

Physical & Mental Requirements:

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.