Senior Clinical Coding Nurse Consultant — RA Leader

Texas Health Institute; Irving, Northern (TX, KY); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

401k contribution

Equity stock purchase

Comprehensive benefits package

Job summary

WellMed, part of the Optum family, is seeking a Senior Clinical Coding Nurse Consultant to implement consistent RA best practices across DataRAP Operations. The role collaborates with clinicians, market leaders and RA teams to ensure compliant coding and efficient workflows that ultimately improve care for our members.

The position requires RN licensure, BSN preferred or equivalent experience, and CPC certification within nine months.

Qualifications

• RN licensed without restrictions; BSN preferred or equivalent RN experience.
• CPC certification required within nine months of hire.
• Knowledge of CMS HCC model, Medicare Advantage, and ICD-10-CM guidelines.
• Strong analytical and time management skills; able to work independently.
• Effective verbal and written communication; able to collaborate with diverse teams.

Responsibilities

• Subject matter expert for RA activities within assigned markets in a matrix structure.
• Collaborate with clinicians and leadership on RA reporting to facilitate improved care.
• Provide analytical interpretation of RA reporting.
• Educate and train on RA metrics with central and regional teams.
• Participate in RA Chart Retrieval Project to provide robust data on members.
• Attend weekly, monthly, quarterly, and annual Business Review meetings related to RA.
• Analyze provider group operations to optimize RA workflows.
• Develop user-friendly initiatives to support practice success.
• Work with DataRAP senior leadership on special projects.

Skills

CMS HCC knowledge

Critical thinking

Independent work

Verbal and written communication

Time management

Education

Bachelor of Science in Nursing (BSN)

CPC Certification (within 9 months)

Tools

MS Office 365

Excel

OneNote

PowerPoint

Job description

WellMed, part of the Optum family, is seeking a Senior Clinical Coding Nurse Consultant to implement consistent RA best practices across DataRAP Operations. The role collaborates with clinicians, market leaders and RA teams to ensure compliant coding and efficient workflows that ultimately improve care for our members.

The position requires RN licensure, BSN preferred or equivalent experience, and CPC certification within nine months.