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Healthcare Advocate

Company UnitedHealth Group
Location Springfield, MO 65897
Update 7 Day 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)

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 HS Diploma/GED with equivalent work experience
Experience in Risk Adjustment and HEDIS / Stars
Knowledge of ICD10, HEDIS and Stars
Intermediate proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)
Experience working effectively with common office software, coding software, EMR and abstracting systems

Preferred Qualifications:
Master's Degree
Certified Professional Coder / CPC-A; equivalent certifications acceptable
4 or more years of clinic or hospital experience and/or managed care experience
CRC certification
Nursing background i.e. LPN, RN, NP
Knowledge of EMR for recording patient visits
Experience in management position in a physician practice
One or more year of coding performed at a health care facility
Knowledge of billing / claims submission and other related actions

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)

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.