Risk Adjustment Specialist

2 months ago

Santa Ana, United States Optum Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**

As a Risk Adjustment Specialist, you will serve as the relationship owner and strategic partner for the Provider Market across the state of Southern California. Your primary goal is to drive provider engagement and the adoption of Optum Risk Adjustment programs through a consultative approach.

If you reside in Southern California, you will have the flexibility to work remotely* as you take on some tough challenges.

**Primary Responsibilities**:

- Serve as the Relationship Owner and Strategic Partner for key markets/provider groups in collaboration with Market Leadership
- Provide guidance and consultative feedback to groups, MSOs and IPAs to drive provider engagement and adoption of Optum program and provide recommendations for improvement (Strategy Meetings)
- Partner with business owners to identify methods to execute on key goals and initiatives
- Effectively manage In-Office Assessment Program
- Ability to review risk adjustment key performance data (Prevalence, RAF, recapture, etc.) to assist in development of programs and initiatives for risk accuracy
- Collaborate and coordinate with stakeholders and project teams
- Deliver effective presentations with targeted audiences that include senior leadership with groups and MSOs
- Provide program progress and updates to leadership
- Work in collaboration with team coders to execute education at provider level
- Work with senior leaders to continue to drive progress and performance. Provide guidance to team members in driving provider engagement and adoption of Optum program and provide recommendations for improvement
- Work with the business to develop program success metrics and ongoing performance metrics
- Provides solid leadership and judgment; effectively build and deepen relationships across business
- Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost
- Ability to travel 70% of time throughout the region, mostly day trips

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**:

- 5+ years of experience working in the healthcare market
- 5+ years of experience working in the risk adjustment space
- Intermediate level of experience analyzing and interpreting data to create tactical action plans
- Demonstrated ability to influence and to drive projects without formal authority
- Proven ability to develop and present to senior leadership/executives
- Currently reside in the Southern California market
- Ability to travel 50-75% of the time within your designated territory

**Preferred Qualifications**:

- CPC, CRC or other coding certification
- 1+ years of coding performed at a health care facility
- Clinical work experience (i.e. LPN, RN, NP)
- Experience in management position in a physician practice
- Experience within the healthcare payer market
- Expertise in chronic condition areas (i.e. oncology, diabetes, etc.)
- Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models
- Knowledge of billing/claims submission and other related actions
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
- At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._
- Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration

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