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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 demonstrating full assessment and suspect closure. 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 open suspect opportunities, and educate providers and offices to ensure they are coding to the highest specificity for both risk adjustment and quality reporting. Work is primarily performed at physician practices on a daily basis.
NOTE: Qualified candidates must live in Virginia, with a preference for the Richmond Metro or the surrounding area for regular travel within the assigned territory region.
If you are located in Richmond Metro, VA region, you’ll enjoy the flexibility to telecommute* as you take on some tough challenges.
- Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting, focused on improving the quality of care for Medicare Advantage Members
- Establish positive, long-term, consultative relationships with physicians, medical groups, and IPAs
- Facilitate risk adjustment suspect closure and improve provider group outcomes
- Act as a lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation.
- Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends and drive educational opportunities
- Conduct chart review quarterly and provide timely feedback to provider to improve reporting on a go forward basis.
- Conduct additional chart reviews such as a quarterly post-visit ACV review and various focused progress notes reviews with provider feedback to improve documentation and coding resulting in improved gap and suspect closure.
- 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), coding for quality care (CPT II) and exclusions (ICD-10-CM), risk adjustment coding practices (ICD-10-CM), and Optum program administration including 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
- Includes up to 75% local travel (Richmond, VA Metro surrounding areas)
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.
- Certified Risk Adjustment Coder Required
- 5+ years of healthcare industry experience
- 1+ years of provider facing experience
- 1+ years with strong knowledge of Medicare Advantage including Stars and Risk Adjustment
- 2+ years of HEDIS/Stars Measures
- 2+ years of experience presenting to Providers, Leadership, and/or Stakeholders
- Microsoft Office experience including PowerPoint and Excel, with exceptional analytical and data representation expertise
- 1+ years of previous experience building relationships with clinical and non-clinical personnel
- 2+ years of experience/knowledge of ICD-10-CM and CPT II coding
- Must be able to provide proof of a valid, unrestricted Driver’s License and proof of current Auto Insurance
- Must be willing to travel up to 75% of the time (Richmond, VA Metro and surrounding area) – Qualified candidates must live in this area to perform daily travel expectations
- Bachelor’s Degree preferred
- Certified Professional Coder with AAPC
- Excellent oral & written communication skills
- Strong presentation skills
- Strong problem-solving skills
- Experience working for a health plan and/or within a provider office
- Registered Nurse
- Knowledge base of clinical standards of care, preventive health, and Stars measures
- Experience with network and provider relations/contracting
- Experience retrieving data from EMRs (electronic medical records)
- Demonstrate a level of knowledge, skill and understanding of ICD-10-CM and CPT coding principles consistent with certification by AAPC
- Previous experience in management or coding position in a provider primary care practice
- Knowledge of billing or claims submission and other related actions
- Bachelor’s degree (preferably in Healthcare or relevant field)
- Good work ethic, desire to succeed, self-starter
- Ability to deliver training materials designed to improve provider compliance
- Ability to use independent judgment, and to manage and impart confidential information
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
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.