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Job Details

Sr. Network Program Coding Educator - Remote in Albuquerque Metro Only


Healthcare Network Director


Albuquerque, New Mexico, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Position in this function support IPA (Independent Provider Association) Providers with ongoing ICD 10 CM Coding Education relating to Medicare Advantage - Risk Adjustment CMS Documentation & Coding Guidelines by providing tools to allow for greater meaningful information exchange to allow providers to identify potential new clinical conditions early, reinforce self-care and prevention strategies, coordinate care, improve overall patient outcomes. This position will be responsible for effectively training clinical documentation skills for complete reporting of medical diagnoses to build an accurate health profile for each individual member.

General Job Profile

  • Generally work is self-directed and not prescribed
  • Works with less structured, more complex issues
  • Serves as a resource to others

If you are located in Albuquerque Metro Area you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Provide coding and documentation improvement education and training to IPA (Independent Provider Association) providers consistent with network goals, objectives and best practices
  • Collaborate with organizational leaders to identify emerging needs and generate solutions
  • Serve as a Coding and Documentation resource to IPA Providers by performing concurrent reviews and targeted chart or HEDIS retrievals in provider offices
  • Coding audit findings, industry updates and common medical documentation issues will be communicated to providers to ensure CMS and Optum compliance guidelines
  • Will perform coding reviews through Internal System
  • Participate in the development and onboarding of various programs for IPA providers
  • Translate concepts into practice
  • Develop and implement effective analysis, research and evaluation of quality measures required for member demographic (Care of Older Adults (COA), Diagnostic and lab testing)
  • Develop and maintain working relationships with our clinic partners, including providers and their support staff in person
  • Ability to work with multiple internal and external partners at various levels of the organization
  • Adhere to project goals / milestones based on identified business needs / timelines, and obtain appropriate approvals
  • Adhere to established guidelines for formatting and templates
  • Functions as part of a collaborative, high functioning coding education team
  • Ability to manage multiple tasks and projects, and forge solid interpersonal relationships within the department, with other departments and with external audiences
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Solid aptitude for quickly troubleshooting and identifying the cause of questionable results within reports, provider documentation or charges submitted
  • This position requires an in-person presence in various provider offices routinely
  • Ability to move, lift and / or push 25+ pounds
  • Maintain flexibility and adjust working hours according to provider needs
  • Adhere to department standards for productivity and performance
  • Adhere to HIPAA Confidentiality Standards
  • Available to attend monthly IPA Team meeting in person

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:

  • Associates Degree in related field, or equivalent experience directly related to the duties and responsibilities of this role
  • Coding Certification from AAPC or AHIMA professional coding association: (Example: CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P, CRC etc.) or RN / LPN with ability to obtain coding certification from AHIMA or AAPC within 12 months of hire
  • 5+ years of coding experience in assignment of ICD-10 diagnostic coding
  • 2+ years of experience with Medicare Advantage – Risk Adjustment CMS Documentation & Coding Guidelines
  • 2+ years of public speaking, talent development and / or education experience
  • Experience in developing and delivering coding education / training to non-coder professionals
  • Superior computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other learning content development and publishing software programs
  • Understanding of medical terminology, pharmacology, body systems and anatomy, physiology, and concepts of disease processes
  • Demonstrated exemplary attention to detail and completeness with a thorough understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse regarding coding and documentation
  • Respond to provider requests by directing them to appropriate internal or external resources
  • Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC
  • Proven customer service centered approach and alignment with UHG Cultural Values

Preferred Qualifications:

  • Unrestricted and active RN license
  • Bachelor's Degree or equivalent work experience
  • Experience creating reports related to quality improvement / performance outcomes
  • Experience with quality measures such as HEDIS
  • Experience with Data RAP, Alliance, Facets systems and any other Electronic Medical Record
  • Leadership skills should include: Setting the example, motivating the team to be high performers and taking the initiative to achieve the outcome
  • Must possess solid analytical, problem-solving, planning, communication, documentation, and organizational skills with meticulous attention to detail
  • Ability to communicate in a clear and understandable manner, both orally and in writing; exercises independent judgment; influences and coordinate the efforts of others over whom one has no direct authority
  • Ability to manage a significant workload and to work efficiently under pressure meeting established deadlines with limited supervision

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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.