Healthcare Advocate - Field Based In Raleigh, NC Or Surrounding Areas

Unitedhealth Group Inc. Raleigh , NC 27611

Posted 4 months ago

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Healthcare Advocate is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise-wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness. Network Program Consultants may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

If you are located in Raleigh, NC, you will have the flexibility to telecommute* as you take on some tough challenges. This will be a telecommute position, but does require being in the field up to 4 days per week.

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

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

  • Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status

  • 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

  • Provide training to provider groups on Medicare Advantage, quality measures (HEDIS) and risk adjustment

  • Coordinate large and small group training sessions in collaboration with the Optum Coding Trainers and Clinical staff

  • Face to face collaboration with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts

  • Manage end-to-end Healthcare Patient Assessment Form program 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

  • CRC, CPC coding certification preferred

Required Qualifications:

  • Bachelor's degree

  • 4 years of provider or hospital experience and / or managed care experience

  • Knowledge of ICD10

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

  • Ability to travel within assigned territory (day trips) 80% of the time

Preferred Qualifications:

  • Certified Professional Coder / CPC-A; CRC certification

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

  • Project Management experience

  • Excellent oral and written communication skills (experience giving group presentations)

  • Strong business acumen and analytical skills

  • Knowledge of managed care, Risk Adjustment, HEDIS and Medicare/Medicaid programs

  • Ability to develop long term relationships

  • Good work ethic and ability to work independently

  • Strong business acumen and analytical skills

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: Risk Adjustment, HEDIS, Medicare, HCC, Coding, ICD-10, CPC, CRC, Raleigh, Durham, Cary, NC, North Carolina Telecommute


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Healthcare Advocate - Field Based In Raleigh, NC Or Surrounding Areas

Unitedhealth Group Inc.