UnitedHealth Group Healthcare Advocate, Risk Adjustment Programs and Strategies - Telecommute within Southern California in Anaheim, California

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)

If you are located in Orange or Los Angeles counties , you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Function independently to 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

  • Out in the field in defined territory, with rare occasion of overnight travel

  • Utilize data analysis to 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

  • Assist providers in understanding the Medicare quality program as well as the 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

  • Support 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

  • Coordinate education activities for ICD10 - HCC coding training to providers and appropriate office staff, as needed

  • Develop and present presentations and training to large and small groups of clinicians, practice managers, and certified coders, developing training to fit specific provider's needs

  • Deliver diagnosis coding tools to providers

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

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

Required Qualifications:

  • Undergraduate degree or equivalent relevant work experience

  • 5+ years of professional experience (ideally in healthcare consulting and strategies, network management, provider data, contracting, coding or nursing experience)

  • Previous direct experience in Risk Adjustment

  • Basic understanding of ICD10

  • Proficiency in MS Office - Excel Intermediate, PowerPoint, and Word

  • Ability to travel up to 50% within a local territory

Preferred Qualifications:

  • Advanced Risk Adjustment experience; working prospective and retrospective programs for RAF improvement; management of RA programs

  • Managed Care experience

  • Presentation skills

  • Network contracting experience

  • Coding certification

  • Clinic or hospital experience and/or managed care experience

  • Knowledge of EMR for recording patient visits

  • Previous experience in a management position in a physician practice

  • 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)

*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.

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