Healthcare Advocate

UnitedHealth Group - Indianapolis, IN3.6

Full-time
There comes a point when you’re ready to take off the training wheels and start guiding others. If that’s where you are today, let’s talk about where you can be tomorrow with our leading, global health care organization. UnitedHealth Group is driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. Here’s where you come in. Your expertise in provider networks can help us build in the next phase of evolution. In this role, you’ll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you’ll discover the resources, backing and opportunities that you’d expect from a Fortune 6 leader.

If you are located in Indiana, you will have the flexibility to telecommute* as you take on some tough challenges.

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 provider's 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

Required Qualifications:
Bachelor’s degree (preferably in Healthcare or relevant field), or equivalent work experience
4+ years of provider or hospital experience and/or managed care experience
Knowledge of ICD10
Proficiency in MS Office: Excel (Intermediate), PowerPoint, and Word
Certified Professional Coder / CPC-A; CRC certification; CCS, RHIA, or willing to obtain CPC within 6 months
Must be able to work effectively with common office software, coding software, EMR, and abstracting systems
Ability to travel up to 75% regionally

Preferred Qualifications:
Previous experience in Risk Adjustment or HEDIS / Stars
Nursing background (i.e., LPN, RN, NP)
Knowledge of EMR for recording patient visits
Previous experience in a management position in a physician practice
Master's degree
1+ years of coding performed at a health care facility
Knowledge of billing / claims submission and other related actions
Certified Professional Coder / CPC-A, CRC certification, CCS, RHIA, or willing to obtain CPC within 6 months
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

  • All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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: HEDIS, Quality, Risk Adjustment, HCA, Healthcare Advocate, Health Care, Healthcare, Telecommute, Remote, Indianapolis, Indiana, IN