Medical Coding Analyst - San Antonio, TX

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The Medical Coding Analyst validates progress notes and enters the appropriate ICD - 9 / ICD - 10 coding into the DataRAP® database utilizing the Centers for Medicare and Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) guidelines. This position is also responsible for timely communication of identified quality issues concerning documentation and validation pertaining to the CMS - HCC methodology and ICD - 9 / ICD - 10 CM coding guidelines back to the provider.

This is a office role but will allow a rotation of working from home 1 week and working from the office 1 week. Obtaining the CPC within 9 months of hire is required. Work Hours are Monday-Friday 8am -5:00pm, no weekends, no on call. Some travel to WellMed clinics will be required based on business needs. The office is located at 5859 Farinon Drive San Antonio, Texas 78249

Primary Responsibilities:
  • Process attestation sheets and progress notes out of the RightFax work queue according to DataRAP® department guidelines
  • Analyze progress notes and documentation sent by providers for validation following CMS guidelines and ICD - 9 / ICD - 10 Coding Manual guidelines and enters final results into appropriate tab of the DataRAP® database
  • Perform the minimum number of validations consistent with established departmental goals
  • Provide clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard as identified by "no plan"
  • Provide clear communication, with use of DataRAP® application, through query to PCP on documentation not meeting standard of basic administrative components to a progress note
  • Ensure accuracy of entry by comparing to outcome of diagnoses on eAttestation post validation entry
  • Associate attestation sheets received into the DataRAP® database to provide tracking for all markets
  • Identify and reports quality concerns and errors to DataRAP® Clinical Process Quality Analyst for review and education
  • Responsible for providing coding support to the DataRAP® Clinical Coding Nurses and to the providers participating in the DataRAP® process


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:
  • High school diploma or GED equivalent
  • CPC certification or proof that certification has been obtained within nine months of hire date from the American Academy of Professional Coders
  • Experience with ICD - 9 / ICD - 10 CM guidelines and coding
  • Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook
  • Ability to travel (locally and non-locally) as determined by business need


Preferred Qualifications:
  • College experience
  • 2+ years of medical coding experience with attention to detail and a high level of accuracy in a clinical or managed care setting
  • Experience with proprietary medical coding systems
  • Ability to analyze facts and exercise sound judgment when arriving at conclusions
  • Ability to effectively report deficiencies with a recommended solution in oral and / or written form


Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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.

Job Keywords: Medical Coding Analyst, Medical Coding, Medical Coder, San Antonio, TX, Texas

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