Senior RA Coding Nurse Consultant

Optum; Irving (TX); On-site; USD 73,000 - 130,000; Full time

Job summary

WellMed, part of the Optum family, is seeking a Senior Clinical Coding Nurse Consultant (Sr. CCNC) to lead risk adjustment (RA) best practices across DataRAP Operations.

In a matrix environment, you will educate teams, analyze RA reporting, and collaborate with clinicians and leadership to improve member care while ensuring compliance. This role requires travel to market sites, an active RN license, and expertise in CMS HCC/ICD-10-CM guidelines to drive accurate coding and reporting for improved

Qualifications

• Bachelor of Science in Nursing with 2+ years RN experience or an associate degree with 4+ years RN experience.
• Current, unrestricted RN license in good standing.
• CPC Certification must be obtained within nine months of hire date (organization funds expenses).
• Knowledge of CMS HCC Model, Medicare Advantage, and ICD-10-CM guidelines.
• Strong time management skills and ability to work independently.
• Excellent verbal and written communication; ability to collaborate with diverse teams.
• MS Office Suite proficiency: Excel, Word, PowerPoint.
• Willingness to travel locally and non-locally; valid driver’s license.

Responsibilities

• Subject matter expert for RA activities within assigned market(s) in a matrix structure.
• Collaborate with clinicians and leadership on RA reporting to improve member 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 member data.
• Attend weekly, monthly, quarterly, and annual RA-related Business Review meetings.
• Analyze provider group operations to optimize RA workflows.
• Develop solution-based, user-friendly RA initiatives with leadership.
• Collaborate with DataRAP senior leadership on special projects.
• Perform other duties as assigned.

Skills

RN experience

Communication skills

Time management

Critical thinking

Independent work

Education

BSN in Nursing

Associate degree in Nursing

Tools

MS Office 365

OneNote

Excel

PowerPoint

Job description

WellMed, part of the Optum family, is seeking a Senior Clinical Coding Nurse Consultant (Sr. CCNC) to lead risk adjustment (RA) best practices across DataRAP Operations.

In a matrix environment, you will educate teams, analyze RA reporting, and collaborate with clinicians and leadership to improve member care while ensuring compliance. This role requires travel to market sites, an active RN license, and expertise in CMS HCC/ICD-10-CM guidelines to drive accurate coding and reporting for improved