Optum Health Coding Risk Adjustment Jobs in Dallas, GA

About The Role

The Healthcare Risk Management & Advisory (HRMA) practice is a high-performing team that works across both corporate engagements, and litigation matters to deliver data-driven solutions to our clients. The healthcare industry is one of the largest, most dynamic, and complex sectors of the world economy and the HRMA team delivers strategic, analytical, financial, data mining and operational expertise through teams who understand the unique industry and regulatory environment in which our clients operate.

We serve clients across the healthcare continuum, including health systems, payors, and life sciences companies, as well as the law firms, banks, and private equity firms with whom they do business.We provide these clients with operational consulting and advisory services that are designed to help them optimize their performance and respond to strategic, operational, regulatory and financial challenges in an industry undergoing unprecedented change.Our multi-disciplinary team is comprised of consultants with expertise in data analytics, finance, accounting, economics, information technology and healthcare operations and regulations, and includes former healthcare executives and medical practitioners all of whom are focused on delivering meaningful results in order to manage change, mitigate risk, ensure compliance, resolve disputes, execute significant business transactions and improve performance.

What You'll Do

Our Senior Directors work within diverse teams of professionals that include experienced nurse reviewers, coding professionals, and physicians to assist clients and counsel in reviewing medical records to independently evaluate the services provided and compliance with various regulations. Reviews may focus on particular coding issues, medical necessity, or clinical documentation improvement. Senior Directors are asked to review medical records, document their findings and rationale for decisions (based on coding, clinical or regulatory requirements), synthesize their observations and trends, and discuss them with project management, client and counsel.

• Examine outpatient, physician office, and inpatient medical records; review principal and secondary diagnoses and procedures, applying strong understanding of clinical documentation and care delivery workflows.

• Validate accuracy of code assignments (ICD-10-CM/PCS, CPT, HCPCS, MS-DRG, HCCs) and confirm appropriate reimbursement based on medical record documentation.

• Ability to research billing, coding, and reimbursement regulations and summarize issues for discussions with client and counsel, citing relevant regulatory sources

• Articulates complex coding and clinical terminology or ambiguous guidance for internal teams, client and counsel.

• Prepare detailed written analyses of medical record reviews and coding findings, including citations to applicable regulatory requirements and coding guidelines.

• Demonstrate in-depth knowledge of clinical documentation requirements, coding guidelines, regulatory requirements, reimbursement methodologies and clinical workflows in the physician office, outpatient and inpatient settings.

• Guide project strategy and approach for coding engagements which may include coordinating team efforts, review of complex findings, and communication of key insights and recommendations to client executives.

• Provides education to physicians and staff on documentation guidelines.

• Review and revise client policies related to coding and clinical documentation

How You'll Grow

We are committed to investing and supporting you in your professional development and we have developed a range of programs focused on fostering leadership, growth and development opportunities. We aim to promote continuous learning and individual skills development through on-the-job learning, self-guided professional development courses and certifications. You'll be assigned a dedicated coach to mentor, guide and support you through regular coaching sessions and serve as an advocate for your professional growth.

As you progress through your career at FTI Consulting, we offer tailored programs for critical professional milestones to ensure you are prepared and empowered to take on your next role.

What You Will Need To Succeed

• Ability to work both independently and as part of a team in a fast-paced, multi-tasking environment with a strong attention to detail

• Ability to interface and be collaborative with team members and client personnel in demanding, deadline-driven situations

• Excellent communication (both written and verbal) and organizational skills.

• Flexibility with respect to assigned tasks and engagements due to challenging deadlines, changing deliverables, and evolving task priorities

• Strong work ethic, eagerness to learn, and motivation to succeed

• Strong critical thinking, problem solving, analytical and presentation skills

Basic Qualifications

• Bachelor's Degree

• Current/active coding certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and/or Certified Outpatient Coder (COC)

• 10+ years of total working experience

• 8+ years medical coding or clinical documentation improvement experience preferably in a consulting/professional services environment.

• Proficient use of grouper software and/or coding reference books to determine appropriate code assignment

• Experience using EMR's such as EPIC, Cerner, Athena, AdvancedMD

• Proficient in use Microsoft Office Suite, including Outlook, Word, Excel and PowerPoint

• Must be willing to travel periodically, some travel may be required (up to 30% annually)

• This role requires travel to clients and FTI offices

• Applicants must be currently authorized to work in the United States on a full-time basis; this position does not provide visa sponsorship

Preferred Qualifications

• Knowledge of APC assignment logic, National Correct Coding Initiative edits, ICD-10-CM/PCS Official Coding Guidelines, AHA Coding Clinic, and CPT Assignment coding guidelines

• Medical Laboratory Scientist (MLS) ASCP Certification or corresponding experience in a laboratory setting

• Testifying, mediation, or arbitration experience

• Demonstrated experience in the fundamentals of auditing and monitoring