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Healthcare Advocate - Field based in Hartford or New Haven, CT

UnitedHealth Group • New Haven, CT

Posted 7 days ago

Job Snapshot

Healthcare - Health Services
Health Care


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Job Description

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 Hartford or New Haven, CT, 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)

  • Previous experience in Risk Adjustment and HEDIS/Stars

  • Knowledge of ICD10, HEDIS and Stars

  • Advanced proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)

  • Must be able to work 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+ 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

  • Previous experience in management position in a physician practice

  • 1+ one 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)

*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: CPC, CRC, LPN, RN, HEDIS, Risk Adjustment, Stars, Hartford, New Haven, CT, Connecticut, telecommute, telecommuter, remote, work from home

Job ID: 2551_756409_0
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