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.
