Healthcare Advocate - Field Based In Pittsburgh, PA

Unitedhealth Group Inc. Pittsburgh , PA 15201

Posted 2 weeks ago

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

If you are located witihin Pittsburgh, PA 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

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's degree (preferably in healthcare or relevant field)

  • Proficiency in MS Office (Excel, PowerPoint and Word)

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

  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Master's degree

  • Nursing background i.e., RN, NP

  • Certified Professional Coder / CPC-A; equivalent certifications acceptable

  • CRC certification

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

  • 1+ years of coding performed at a health care facility

  • Previous experience in management position in a physician practice

  • Previous experience in Risk Adjustment and HEDIS/Stars

  • Knowledge of EMR for recording patient visits

  • Knowledge of billing/claims submission and other related actions

  • Knowledge of ICD10, HEDIS and Stars

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

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 bylower 48 law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Healthcare Advocate - Field Based In Pittsburgh, PA

Unitedhealth Group Inc.