Healthcare Advocate – Remote

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

If you are located in New Jersey or New York, you will have the flexibility to work remotely as you take on some tough challenges. Field Position – must live in NY or NJ to perform regional travel requirements of the role.

Primary Responsibilities:

Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members. Will be out in the field 80% of time in defined territory with rare occasion of overnight travel

Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources

Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals

Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity

Manage end-to-end Risk and Quality Client Programs such as Healthcare Patient Assessment Form on ensuring correct delivery of data/forms to the correct providers, and the return of the data to coding ops, ensuring accurate payments are occurring for each provider based on client contract

Consult with provider groups on gaps in documentation and coding

Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding

Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership

Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

Provides ICD10 – HCC coding training to providers and appropriate office staff as needed

Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific providers needs

Develops and delivers diagnosis coding tools to providers

Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices

Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts

Assist in collecting charts where necessary for analysis

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:

1 years of experience working in the Healthcare industry

Experience in Risk Adjustment and/or HEDIS/Stars

Knowledge of ICD10 coding guidelines

Proficient using MS Office Tools (Excel [Pivot tables, excel functions], PowerPoint and Word)

Ability to work effectively with common office software, coding software, EMR and abstracting systems

Ability to provide proof of a valid Driver’s License and current Auto Insurance

Live in NY or NJ to perform the duties of this role (daily regional travel is required)

Ability/willingness to travel approximately 75% of the time in regional areas of either NY or NJ (must live in this area to meet this expectation)

Preferred Qualifications:

Certified Professional Coder / CPC-A; equivalent certifications

CRC certification

4 years of clinic or hospital experience and/or managed care experience

1 years of coding performed at a health care facility

Experience in management position in a physician practice

Nursing background i.e. LPN, RN, NP

Knowledge of EMR for recording patient visits

Knowledge of billing/claims submission and other related actions

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

New Yorkor New Jersey Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.