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Practice Performance and Coding Accuracy Consultant - Telecommute in RI job in Atlanta at UnitedHealth Group

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Practice Performance and Coding Accuracy Consultant - Telecommute in RI at UnitedHealth Group

Practice Performance and Coding Accuracy Consultant - Telecommute in RI

UnitedHealth Group Work From Home, GA Full Time

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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. 

The Practice Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy.  The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity.  Work is primarily performed at physician practices on a daily basis.

If you are located within the state of Connecticut or Western Massachusetts, 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 incentive programs focused on improving the quality of care for Medicare Advantage Members
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes
  • Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Provider Scorecard) to analyze data and prioritize gap closure, identify trends and drive educational opportunities
  • Conduct chart review quarterly and provide timely feedback to provider to implement change on a go forward basis
  • Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
  • Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), risk adjustment coding practices, and Optum program administration, use of plan tools, reports and systems
  • Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
  • Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
  • Includes up to 50% local travel

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 or equivalent experience
  • Certified Risk Coder (CRC) or Certified Professional Coder (CPC)
  • 5+ years of healthcare industry experience
  • 1+ years of provider facing experience
  • Experience building relationships with clinical and non-clinical personnel
  • Microsoft Office experience including Excel with exceptional analytical and data representation expertise
  • Solid knowledge of Medicare Advantage including Stars and Risk Adjustment
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance. 

Preferred Qualifications:

  • Experience working for a health plan and/or within a provider office
  • Experience with network and provider relations/contracting
  • Experience retrieving data from EMRs (electronic medical records)
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Solid communication and presentation skills
  • Sound problem-solving skills

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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:  Healthcare, provider facing, Medicare Advantage, STARs, Rik Adjustment, Certified Risk Coder, Certified Professional Coder, CRC, CPC, EMR, electronic medical records, telecommute, remote, work fro home, Johnston, Rhode Island, RI

 

Recommended Skills

  • Complex Problem Solving
  • Medicare Advantage
  • Healthcare Effectiveness Data And Information Set
  • Microsoft Access
  • Training
  • Certified Professional Coder
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